|
STEM SPLINED V2 BMT 23X120
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 23X40
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 23X40
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 23X80
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 23X80
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 24X120
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 24X120
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 24X40
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 24X40
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 24X80
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM SPLINED V2 BMT 24X80
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM S-ROM 18*13*160 NK 36+8L
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM 18*13*160 NK 36+8L
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM 20*15*165 NK 36+8L
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM 20*15*165 NK 36+8L
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM 22*17*165 NK 36+8L
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM 22*17*165 NK 36+8L
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 12*06*115 30 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 12*06*115 30 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 12*07*115 30 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 12*07*115 30 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 14*08*130 30 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 14*08*130 30 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 14*09*130 30 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 14*09*130 30 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
