|
STEM CEMENTED OSS IM 16X150
|
Facility
|
IP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 16X150
|
Facility
|
OP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem Medicaid |
$4,531.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Humana KY Medicaid |
$4,531.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,577.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,622.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 17X150
|
Facility
|
IP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 17X150
|
Facility
|
OP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem Medicaid |
$4,531.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Humana KY Medicaid |
$4,531.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,577.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,622.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 17X225
|
Facility
|
OP
|
$15,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.50 |
| Max. Negotiated Rate |
$15,057.60 |
| Rate for Payer: Aetna Commercial |
$12,077.45
|
| Rate for Payer: Anthem Medicaid |
$5,394.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,234.30
|
| Rate for Payer: Cash Price |
$7,842.50
|
| Rate for Payer: Cigna Commercial |
$13,018.55
|
| Rate for Payer: First Health Commercial |
$14,900.75
|
| Rate for Payer: Humana Commercial |
$13,332.25
|
| Rate for Payer: Humana KY Medicaid |
$5,394.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,448.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,861.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,575.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,502.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,802.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,763.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,822.65
|
| Rate for Payer: PHCS Commercial |
$15,057.60
|
| Rate for Payer: United Healthcare All Payer |
$13,802.80
|
|
|
STEM CEMENTED OSS IM 17X225
|
Facility
|
IP
|
$15,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.50 |
| Max. Negotiated Rate |
$15,057.60 |
| Rate for Payer: Aetna Commercial |
$12,077.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,234.30
|
| Rate for Payer: Cash Price |
$7,842.50
|
| Rate for Payer: Cigna Commercial |
$13,018.55
|
| Rate for Payer: First Health Commercial |
$14,900.75
|
| Rate for Payer: Humana Commercial |
$13,332.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,861.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,575.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,802.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,763.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,822.65
|
| Rate for Payer: PHCS Commercial |
$15,057.60
|
| Rate for Payer: United Healthcare All Payer |
$13,802.80
|
|
|
STEM CEMENTED OSS IM 17X300MM
|
Facility
|
IP
|
$16,219.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,865.78 |
| Max. Negotiated Rate |
$15,570.51 |
| Rate for Payer: Aetna Commercial |
$12,488.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,651.04
|
| Rate for Payer: Cash Price |
$8,109.64
|
| Rate for Payer: Cigna Commercial |
$13,462.00
|
| Rate for Payer: First Health Commercial |
$15,408.32
|
| Rate for Payer: Humana Commercial |
$13,786.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,299.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,969.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,865.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,272.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,164.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,975.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,110.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,191.30
|
| Rate for Payer: PHCS Commercial |
$15,570.51
|
| Rate for Payer: United Healthcare All Payer |
$14,272.97
|
|
|
STEM CEMENTED OSS IM 17X300MM
|
Facility
|
OP
|
$16,219.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,865.78 |
| Max. Negotiated Rate |
$15,570.51 |
| Rate for Payer: Aetna Commercial |
$12,488.85
|
| Rate for Payer: Anthem Medicaid |
$5,577.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,651.04
|
| Rate for Payer: Cash Price |
$8,109.64
|
| Rate for Payer: Cigna Commercial |
$13,462.00
|
| Rate for Payer: First Health Commercial |
$15,408.32
|
| Rate for Payer: Humana Commercial |
$13,786.39
|
| Rate for Payer: Humana KY Medicaid |
$5,577.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,634.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,299.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,969.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,865.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,689.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,272.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,164.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,975.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,110.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,191.30
|
| Rate for Payer: PHCS Commercial |
$15,570.51
|
| Rate for Payer: United Healthcare All Payer |
$14,272.97
|
|
|
STEM CEMENTED OSS IM 17X90MM
|
Facility
|
OP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem Medicaid |
$4,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Humana KY Medicaid |
$4,815.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,864.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,912.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
STEM CEMENTED OSS IM 17X90MM
|
Facility
|
IP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
STEM CEMENTED OSS IM 18X150
|
Facility
|
OP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem Medicaid |
$4,531.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Humana KY Medicaid |
$4,531.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,577.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,622.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 18X150
|
Facility
|
IP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 9X90MM
|
Facility
|
IP
|
$13,144.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,943.43 |
| Max. Negotiated Rate |
$12,618.97 |
| Rate for Payer: Aetna Commercial |
$10,121.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,252.91
|
| Rate for Payer: Cash Price |
$6,572.38
|
| Rate for Payer: Cigna Commercial |
$10,910.15
|
| Rate for Payer: First Health Commercial |
$12,487.52
|
| Rate for Payer: Humana Commercial |
$11,173.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,778.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,700.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,943.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,567.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,858.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,515.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,435.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,069.88
|
| Rate for Payer: PHCS Commercial |
$12,618.97
|
| Rate for Payer: United Healthcare All Payer |
$11,567.39
|
|
|
STEM CEMENTED OSS IM 9X90MM
|
Facility
|
OP
|
$13,144.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,943.43 |
| Max. Negotiated Rate |
$12,618.97 |
| Rate for Payer: Aetna Commercial |
$10,121.47
|
| Rate for Payer: Anthem Medicaid |
$4,520.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,252.91
|
| Rate for Payer: Cash Price |
$6,572.38
|
| Rate for Payer: Cigna Commercial |
$10,910.15
|
| Rate for Payer: First Health Commercial |
$12,487.52
|
| Rate for Payer: Humana Commercial |
$11,173.05
|
| Rate for Payer: Humana KY Medicaid |
$4,520.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,566.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,778.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,700.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,943.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,611.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,567.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,858.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,515.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,435.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,069.88
|
| Rate for Payer: PHCS Commercial |
$12,618.97
|
| Rate for Payer: United Healthcare All Payer |
$11,567.39
|
|
|
STEM CEMNTD OSS SMTH 90ST-10
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CEMNTD OSS SMTH 90ST-10
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CEM PROX TIB OSS 11X150
|
Facility
|
IP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEM PROX TIB OSS 11X150
|
Facility
|
OP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem Medicaid |
$4,531.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Humana KY Medicaid |
$4,531.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,577.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,622.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEM PROX TIB OSS 13X150
|
Facility
|
OP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem Medicaid |
$4,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Humana KY Medicaid |
$4,815.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,864.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,912.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
STEM CEM PROX TIB OSS 13X150
|
Facility
|
IP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
STEM CEM PROX TIB OSS 15X150
|
Facility
|
IP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
STEM CEM PROX TIB OSS 15X150
|
Facility
|
OP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem Medicaid |
$4,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Humana KY Medicaid |
$4,815.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,864.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,912.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
STEM CMTED SMTH OSS 150BW-11
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150BW-11
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150BW-12
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
