|
STEM REDPTSLVLSMONO SZ25 240MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ26 240MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ26 240MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ27 240MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ27 240MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REINFORCD HIPMOLD 9X125MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFORCD HIPMOLD 9X125MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 11X135MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 11X135MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 11X200MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 11X200MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 13X145MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 13X145MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 13X200MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 13X200MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 15X155MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 15X155MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 15X200MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 15X200MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 17X165MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 17X165MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 17X200MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIPMOLD 17X200MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIP MOLD 9X200MM
|
Facility
|
IP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
|
STEM REINFRCD HIP MOLD 9X200MM
|
Facility
|
OP
|
$9,924.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.22 |
| Max. Negotiated Rate |
$9,527.81 |
| Rate for Payer: Aetna Commercial |
$7,642.10
|
| Rate for Payer: Anthem Medicaid |
$3,413.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,741.34
|
| Rate for Payer: Cash Price |
$4,962.40
|
| Rate for Payer: Cigna Commercial |
$8,237.58
|
| Rate for Payer: First Health Commercial |
$9,428.56
|
| Rate for Payer: Humana Commercial |
$8,436.08
|
| Rate for Payer: Humana KY Medicaid |
$3,413.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,138.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,324.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.69
|
| Rate for Payer: PHCS Commercial |
$9,527.81
|
| Rate for Payer: United Healthcare All Payer |
$8,733.82
|
|
