|
STEM REV 3D COATED SZ 12
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 13
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM REV 3D COATED SZ 13
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM REV 3D COATED SZ 14
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 14
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 15
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 15
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 5
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 5
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 6
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 6
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 7
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 7
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 8
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 8
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 9
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 9
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV APEX COATED SZ 11
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV APEX COATED SZ 11
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REVER REVIS SZ 12*180
|
Facility
|
IP
|
$14,158.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.64 |
| Max. Negotiated Rate |
$13,592.40 |
| Rate for Payer: Aetna Commercial |
$10,902.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,043.82
|
| Rate for Payer: Cash Price |
$7,079.38
|
| Rate for Payer: Cigna Commercial |
$11,751.76
|
| Rate for Payer: First Health Commercial |
$13,450.81
|
| Rate for Payer: Humana Commercial |
$12,034.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,610.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,449.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,247.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,459.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,619.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,389.21
|
| Rate for Payer: PHCS Commercial |
$13,592.40
|
| Rate for Payer: United Healthcare All Payer |
$12,459.70
|
|
|
STEM REVER REVIS SZ 12*180
|
Facility
|
OP
|
$14,158.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.64 |
| Max. Negotiated Rate |
$13,592.40 |
| Rate for Payer: Aetna Commercial |
$10,902.24
|
| Rate for Payer: Anthem Medicaid |
$4,869.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,043.82
|
| Rate for Payer: Cash Price |
$7,079.38
|
| Rate for Payer: Cigna Commercial |
$11,751.76
|
| Rate for Payer: First Health Commercial |
$13,450.81
|
| Rate for Payer: Humana Commercial |
$12,034.94
|
| Rate for Payer: Humana KY Medicaid |
$4,869.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,918.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,610.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,449.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,247.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,459.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,619.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,389.21
|
| Rate for Payer: PHCS Commercial |
$13,592.40
|
| Rate for Payer: United Healthcare All Payer |
$12,459.70
|
|
|
STEM REVER REVIS SZ 6*180
|
Facility
|
OP
|
$14,158.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.64 |
| Max. Negotiated Rate |
$13,592.40 |
| Rate for Payer: Aetna Commercial |
$10,902.24
|
| Rate for Payer: Anthem Medicaid |
$4,869.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,043.82
|
| Rate for Payer: Cash Price |
$7,079.38
|
| Rate for Payer: Cigna Commercial |
$11,751.76
|
| Rate for Payer: First Health Commercial |
$13,450.81
|
| Rate for Payer: Humana Commercial |
$12,034.94
|
| Rate for Payer: Humana KY Medicaid |
$4,869.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,918.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,610.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,449.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,247.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,459.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,619.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,389.21
|
| Rate for Payer: PHCS Commercial |
$13,592.40
|
| Rate for Payer: United Healthcare All Payer |
$12,459.70
|
|
|
STEM REVER REVIS SZ 6*180
|
Facility
|
IP
|
$14,158.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.64 |
| Max. Negotiated Rate |
$13,592.40 |
| Rate for Payer: Aetna Commercial |
$10,902.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,043.82
|
| Rate for Payer: Cash Price |
$7,079.38
|
| Rate for Payer: Cigna Commercial |
$11,751.76
|
| Rate for Payer: First Health Commercial |
$13,450.81
|
| Rate for Payer: Humana Commercial |
$12,034.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,610.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,449.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,247.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,459.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,619.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,389.21
|
| Rate for Payer: PHCS Commercial |
$13,592.40
|
| Rate for Payer: United Healthcare All Payer |
$12,459.70
|
|
|
STEM REVER REVIS SZ 9*180
|
Facility
|
OP
|
$14,158.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.64 |
| Max. Negotiated Rate |
$13,592.40 |
| Rate for Payer: Aetna Commercial |
$10,902.24
|
| Rate for Payer: Anthem Medicaid |
$4,869.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,043.82
|
| Rate for Payer: Cash Price |
$7,079.38
|
| Rate for Payer: Cigna Commercial |
$11,751.76
|
| Rate for Payer: First Health Commercial |
$13,450.81
|
| Rate for Payer: Humana Commercial |
$12,034.94
|
| Rate for Payer: Humana KY Medicaid |
$4,869.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,918.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,610.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,449.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,247.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,459.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,619.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,389.21
|
| Rate for Payer: PHCS Commercial |
$13,592.40
|
| Rate for Payer: United Healthcare All Payer |
$12,459.70
|
|
|
STEM REVER REVIS SZ 9*180
|
Facility
|
IP
|
$14,158.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.64 |
| Max. Negotiated Rate |
$13,592.40 |
| Rate for Payer: Aetna Commercial |
$10,902.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,043.82
|
| Rate for Payer: Cash Price |
$7,079.38
|
| Rate for Payer: Cigna Commercial |
$11,751.76
|
| Rate for Payer: First Health Commercial |
$13,450.81
|
| Rate for Payer: Humana Commercial |
$12,034.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,610.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,449.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,247.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,459.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,619.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,389.21
|
| Rate for Payer: PHCS Commercial |
$13,592.40
|
| Rate for Payer: United Healthcare All Payer |
$12,459.70
|
|
