|
STEM TAPRLOC MCROP FMRL 12.5MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 12.5MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 13.5MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 13.5MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 15.0MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 15.0MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 17.5MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 17.5MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 20.0MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 20.0MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 22.5MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROP FMRL 22.5MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 4.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 4.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 5.0
|
Facility
|
IP
|
$13,538.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.97 |
| Max. Negotiated Rate |
$12,996.72 |
| Rate for Payer: Aetna Commercial |
$10,424.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,559.84
|
| Rate for Payer: Cash Price |
$6,769.12
|
| Rate for Payer: Cigna Commercial |
$11,236.75
|
| Rate for Payer: First Health Commercial |
$12,861.34
|
| Rate for Payer: Humana Commercial |
$11,507.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,101.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,991.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,061.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,913.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,153.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,707.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,196.86
|
| Rate for Payer: PHCS Commercial |
$12,996.72
|
| Rate for Payer: United Healthcare All Payer |
$11,913.66
|
|
|
STEM TAPRLOC MCROPLSTY STD 5.0
|
Facility
|
OP
|
$13,538.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.97 |
| Max. Negotiated Rate |
$12,996.72 |
| Rate for Payer: Aetna Commercial |
$10,424.45
|
| Rate for Payer: Anthem Medicaid |
$4,655.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,559.84
|
| Rate for Payer: Cash Price |
$6,769.12
|
| Rate for Payer: Cigna Commercial |
$11,236.75
|
| Rate for Payer: First Health Commercial |
$12,861.34
|
| Rate for Payer: Humana Commercial |
$11,507.51
|
| Rate for Payer: Humana KY Medicaid |
$4,655.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,703.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,101.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,991.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,061.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,913.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,153.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,707.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,196.86
|
| Rate for Payer: PHCS Commercial |
$12,996.72
|
| Rate for Payer: United Healthcare All Payer |
$11,913.66
|
|
|
STEM TAPRLOC MCROPLSTY STD 6.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 6.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 7.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 7.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 8.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 8.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 9.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY STD 9.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCROPLSTY XR 10.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
