|
STEM REVERS HUMERAL SZ 6
|
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 REVERS HUMERAL SZ 6
|
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 REVERS HUMERAL SZ 8
|
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 REVERS HUMERAL SZ 8
|
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 REVERS HUM UNIVERS
|
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 REVERS HUM UNIVERS
|
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 RHEAD LATERAL SZ 3
|
Facility
|
OP
|
$20,122.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.95 |
| Max. Negotiated Rate |
$19,317.79 |
| Rate for Payer: Aetna Commercial |
$15,494.48
|
| Rate for Payer: Anthem Medicaid |
$6,920.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,695.71
|
| Rate for Payer: Cash Price |
$10,061.35
|
| Rate for Payer: Cigna Commercial |
$16,701.84
|
| Rate for Payer: First Health Commercial |
$19,116.56
|
| Rate for Payer: Humana Commercial |
$17,104.30
|
| Rate for Payer: Humana KY Medicaid |
$6,920.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,990.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,500.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,850.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,036.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,059.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,707.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,092.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,024.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,615.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.04
|
| Rate for Payer: PHCS Commercial |
$19,317.79
|
| Rate for Payer: United Healthcare All Payer |
$17,707.98
|
|
|
STEM RHEAD LATERAL SZ 3
|
Facility
|
IP
|
$20,122.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.95 |
| Max. Negotiated Rate |
$19,317.79 |
| Rate for Payer: Aetna Commercial |
$15,494.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,695.71
|
| Rate for Payer: Cash Price |
$10,061.35
|
| Rate for Payer: Cigna Commercial |
$16,701.84
|
| Rate for Payer: First Health Commercial |
$19,116.56
|
| Rate for Payer: Humana Commercial |
$17,104.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,500.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,850.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,036.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,707.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,092.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,024.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,615.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.04
|
| Rate for Payer: PHCS Commercial |
$19,317.79
|
| Rate for Payer: United Healthcare All Payer |
$17,707.98
|
|
|
STEM SEG BOWED VSS 12MMX190MM
|
Facility
|
IP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 12MMX190MM
|
Facility
|
OP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem Medicaid |
$7,356.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Humana KY Medicaid |
$7,356.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 13MMX190MM
|
Facility
|
OP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem Medicaid |
$7,356.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Humana KY Medicaid |
$7,356.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 13MMX190MM
|
Facility
|
IP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 14MMX190MM
|
Facility
|
IP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 14MMX190MM
|
Facility
|
OP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem Medicaid |
$7,356.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Humana KY Medicaid |
$7,356.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 15MMX190MM
|
Facility
|
IP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 15MMX190MM
|
Facility
|
OP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem Medicaid |
$7,356.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Humana KY Medicaid |
$7,356.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 16MMX190MM
|
Facility
|
IP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 16MMX190MM
|
Facility
|
OP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem Medicaid |
$7,356.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Humana KY Medicaid |
$7,356.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 17MMX190MM
|
Facility
|
OP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem Medicaid |
$7,356.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Humana KY Medicaid |
$7,356.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 17MMX190MM
|
Facility
|
IP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 18MMX190MM
|
Facility
|
IP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 18MMX190MM
|
Facility
|
OP
|
$21,392.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,781.05 |
| Max. Negotiated Rate |
$20,536.97 |
| Rate for Payer: Aetna Commercial |
$16,472.36
|
| Rate for Payer: Anthem Medicaid |
$7,356.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,686.29
|
| Rate for Payer: Cash Price |
$10,696.34
|
| Rate for Payer: Cigna Commercial |
$17,755.92
|
| Rate for Payer: First Health Commercial |
$20,323.05
|
| Rate for Payer: Humana Commercial |
$18,183.78
|
| Rate for Payer: Humana KY Medicaid |
$7,356.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,825.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,044.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.73
|
| Rate for Payer: PHCS Commercial |
$20,536.97
|
| Rate for Payer: United Healthcare All Payer |
$18,825.56
|
|
|
STEM SEG BOWED VSS 19MMX190MM
|
Facility
|
OP
|
$21,391.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,780.86 |
| Max. Negotiated Rate |
$20,535.57 |
| Rate for Payer: Aetna Commercial |
$16,471.24
|
| Rate for Payer: Anthem Medicaid |
$7,356.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,685.15
|
| Rate for Payer: Cash Price |
$10,695.61
|
| Rate for Payer: Cigna Commercial |
$17,754.71
|
| Rate for Payer: First Health Commercial |
$20,321.66
|
| Rate for Payer: Humana Commercial |
$18,182.54
|
| Rate for Payer: Humana KY Medicaid |
$7,356.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,431.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,540.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,786.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,504.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,824.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,043.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,780.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.28
|
| Rate for Payer: PHCS Commercial |
$20,535.57
|
| Rate for Payer: United Healthcare All Payer |
$18,824.27
|
|
|
STEM SEG BOWED VSS 19MMX190MM
|
Facility
|
IP
|
$21,391.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,780.86 |
| Max. Negotiated Rate |
$20,535.57 |
| Rate for Payer: Aetna Commercial |
$16,471.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,685.15
|
| Rate for Payer: Cash Price |
$10,695.61
|
| Rate for Payer: Cigna Commercial |
$17,754.71
|
| Rate for Payer: First Health Commercial |
$20,321.66
|
| Rate for Payer: Humana Commercial |
$18,182.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,540.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,786.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,417.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,824.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,043.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,780.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.28
|
| Rate for Payer: PHCS Commercial |
$20,535.57
|
| Rate for Payer: United Healthcare All Payer |
$18,824.27
|
|
|
STEM SEG STR VSS 12MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
