|
STEM POROUS OSS IM 20.5X150
|
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 20.5X150
|
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 21.5X150
|
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 21.5X150
|
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 22.5X150
|
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 22.5X150
|
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 POR PROX TIB OSS 12.5*150
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM POR PROX TIB OSS 12.5*150
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM POR PROX TIB OSS 14.5*150
|
Facility
|
IP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM POR PROX TIB OSS 14.5*150
|
Facility
|
OP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem Medicaid |
$5,220.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Humana KY Medicaid |
$5,220.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,274.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,325.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM POR PROX TIB OSS 16.5*150
|
Facility
|
OP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem Medicaid |
$5,220.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Humana KY Medicaid |
$5,220.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,274.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,325.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM POR PROX TIB OSS 16.5*150
|
Facility
|
IP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM PROX TIB POR OSS 10.5X150
|
Facility
|
OP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem Medicaid |
$5,220.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Humana KY Medicaid |
$5,220.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,274.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,325.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM PROX TIB POR OSS 10.5X150
|
Facility
|
IP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM REDAPT SLVLS HOSZ12 300MM
|
Facility
|
OP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem Medicaid |
$12,647.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Humana KY Medicaid |
$12,647.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,776.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,901.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ12 300MM
|
Facility
|
IP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ13 300MM
|
Facility
|
OP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem Medicaid |
$12,647.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Humana KY Medicaid |
$12,647.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,776.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,901.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ13 300MM
|
Facility
|
IP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ14 300MM
|
Facility
|
OP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem Medicaid |
$12,647.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Humana KY Medicaid |
$12,647.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,776.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,901.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ14 300MM
|
Facility
|
IP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ15 300MM
|
Facility
|
IP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ15 300MM
|
Facility
|
OP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem Medicaid |
$12,647.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Humana KY Medicaid |
$12,647.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,776.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,901.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ16 300MM
|
Facility
|
IP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ16 300MM
|
Facility
|
OP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem Medicaid |
$12,647.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Humana KY Medicaid |
$12,647.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,776.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,901.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
|
STEM REDAPT SLVLS HOSZ17 300MM
|
Facility
|
IP
|
$36,777.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,781.05 |
| Max. Negotiated Rate |
$35,306.20 |
| Rate for Payer: Aetna Commercial |
$28,318.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.29
|
| Rate for Payer: Cash Price |
$18,388.64
|
| Rate for Payer: Cigna Commercial |
$30,525.15
|
| Rate for Payer: First Health Commercial |
$34,938.43
|
| Rate for Payer: Humana Commercial |
$31,260.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,364.02
|
| Rate for Payer: Ohio Health Group HMO |
$27,582.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,355.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,400.96
|
| Rate for Payer: PHCS Commercial |
$35,306.20
|
| Rate for Payer: United Healthcare All Payer |
$32,364.02
|
|
