|
STEM POROUS OSS IM 15.5X90
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X150
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X150
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X225
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X225
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X300
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X300
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X90
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 16.5X90
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 17.5X150
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 17.5X150
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 17.5X90
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 17.5X90
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X150
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X150
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X225
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X225
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X300
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X300
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X90
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 18.5X90
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 19.5X150
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 19.5X150
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 19.5X90
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 19.5X90
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
