|
STEM OMNIFIT CEMENT #5 250R
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 300L
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 300L
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 300R
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 300R
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 350L
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 350L
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 350R
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #5 350R
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 200L
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 200L
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 200R
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 200R
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 250L
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 250L
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 250R
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 250R
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 300L
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 300L
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 300R
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 300R
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 350L
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 350L
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 350R
|
Facility
|
OP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem Medicaid |
$6,033.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Humana KY Medicaid |
$6,033.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,094.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,154.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
|
STEM OMNIFIT CEMENT #7 350R
|
Facility
|
IP
|
$17,543.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$16,841.32 |
| Rate for Payer: Aetna Commercial |
$13,508.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,683.57
|
| Rate for Payer: Cash Price |
$8,771.52
|
| Rate for Payer: Cigna Commercial |
$14,560.72
|
| Rate for Payer: First Health Commercial |
$16,665.89
|
| Rate for Payer: Humana Commercial |
$14,911.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,385.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,946.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,262.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,437.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,157.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.34
|
| Rate for Payer: PHCS Commercial |
$16,841.32
|
| Rate for Payer: United Healthcare All Payer |
$15,437.88
|
|
