|
STEM EXT BMT KNETRL 18*160 BOW
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 18*160 BOW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 18*200 BOW
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 18*200 BOW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 20*160 BOW
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 20*160 BOW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 20*200 BOW
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 20*200 BOW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 22*160 BOW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 22*160 BOW
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 22*200 BOW
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT BMT KNETRL 22*200 BOW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT CANAL FILL ST 17*140
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXT CANAL FILL ST 17*140
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENDER CEMENTED 155MM
|
Facility
|
OP
|
$5,114.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,534.20 |
| Max. Negotiated Rate |
$4,909.44 |
| Rate for Payer: Aetna Commercial |
$3,937.78
|
| Rate for Payer: Anthem Medicaid |
$1,758.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,988.92
|
| Rate for Payer: Cash Price |
$2,557.00
|
| Rate for Payer: Cigna Commercial |
$4,244.62
|
| Rate for Payer: First Health Commercial |
$4,858.30
|
| Rate for Payer: Humana Commercial |
$4,346.90
|
| Rate for Payer: Humana KY Medicaid |
$1,758.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,776.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,193.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,774.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,534.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,793.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,500.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,835.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,449.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,528.66
|
| Rate for Payer: PHCS Commercial |
$4,909.44
|
| Rate for Payer: United Healthcare All Payer |
$4,500.32
|
|
|
STEM EXTENDER CEMENTED 155MM
|
Facility
|
IP
|
$5,114.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,534.20 |
| Max. Negotiated Rate |
$4,909.44 |
| Rate for Payer: Aetna Commercial |
$3,937.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,988.92
|
| Rate for Payer: Cash Price |
$2,557.00
|
| Rate for Payer: Cigna Commercial |
$4,244.62
|
| Rate for Payer: First Health Commercial |
$4,858.30
|
| Rate for Payer: Humana Commercial |
$4,346.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,193.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,774.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,534.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,500.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,835.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,449.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,528.66
|
| Rate for Payer: PHCS Commercial |
$4,909.44
|
| Rate for Payer: United Healthcare All Payer |
$4,500.32
|
|
|
STEM EXTENDER CEMENTED 40MM
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
STEM EXTENDER CEMENTED 40MM
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem Medicaid |
$1,747.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Humana KY Medicaid |
$1,747.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,765.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,782.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
STEM EXTENDER CEMENTED 80MM
|
Facility
|
IP
|
$5,396.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.80 |
| Max. Negotiated Rate |
$5,180.16 |
| Rate for Payer: Aetna Commercial |
$4,154.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.88
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$4,478.68
|
| Rate for Payer: First Health Commercial |
$5,126.20
|
| Rate for Payer: Humana Commercial |
$4,586.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,982.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,618.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,047.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,694.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,723.24
|
| Rate for Payer: PHCS Commercial |
$5,180.16
|
| Rate for Payer: United Healthcare All Payer |
$4,748.48
|
|
|
STEM EXTENDER CEMENTED 80MM
|
Facility
|
OP
|
$5,396.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.80 |
| Max. Negotiated Rate |
$5,180.16 |
| Rate for Payer: Aetna Commercial |
$4,154.92
|
| Rate for Payer: Anthem Medicaid |
$1,855.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.88
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$4,478.68
|
| Rate for Payer: First Health Commercial |
$5,126.20
|
| Rate for Payer: Humana Commercial |
$4,586.60
|
| Rate for Payer: Humana KY Medicaid |
$1,855.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,874.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,982.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,618.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,892.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,047.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,694.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,723.24
|
| Rate for Payer: PHCS Commercial |
$5,180.16
|
| Rate for Payer: United Healthcare All Payer |
$4,748.48
|
|
|
STEM EXTENSION FLTED ST 10*65M
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,799.82 |
| Max. Negotiated Rate |
$8,959.44 |
| Rate for Payer: Aetna Commercial |
$7,186.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,279.55
|
| Rate for Payer: Cash Price |
$4,666.38
|
| Rate for Payer: Cigna Commercial |
$7,746.18
|
| Rate for Payer: First Health Commercial |
$8,866.11
|
| Rate for Payer: Humana Commercial |
$7,932.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,652.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,887.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,799.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,212.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,999.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,119.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,439.60
|
| Rate for Payer: PHCS Commercial |
$8,959.44
|
| Rate for Payer: United Healthcare All Payer |
$8,212.82
|
|
|
STEM EXTENSION FLTED ST 10*65M
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,799.82 |
| Max. Negotiated Rate |
$8,959.44 |
| Rate for Payer: Aetna Commercial |
$7,186.22
|
| Rate for Payer: Anthem Medicaid |
$3,209.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,279.55
|
| Rate for Payer: Cash Price |
$4,666.38
|
| Rate for Payer: Cigna Commercial |
$7,746.18
|
| Rate for Payer: First Health Commercial |
$8,866.11
|
| Rate for Payer: Humana Commercial |
$7,932.84
|
| Rate for Payer: Humana KY Medicaid |
$3,209.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,652.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,887.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,799.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,273.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,212.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,999.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,119.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,439.60
|
| Rate for Payer: PHCS Commercial |
$8,959.44
|
| Rate for Payer: United Healthcare All Payer |
$8,212.82
|
|
|
STEM EXTENSION FLTED ST 12X100
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLTED ST 12X100
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLTED ST 14X100
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
