|
STEM OMNIFIT CEMENT #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 PF EXT FLT 10MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 10MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 10MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 10MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 11MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 11MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 11MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 11MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 12MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
