|
STEM EXTNSN GB BMT 20X200 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 22X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 22X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 22X200 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 22X200 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM FEM 12/14 135^ STD SZ 10
|
Facility
|
IP
|
$78,518.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,555.54 |
| Max. Negotiated Rate |
$75,377.74 |
| Rate for Payer: Aetna Commercial |
$60,459.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,244.41
|
| Rate for Payer: Cash Price |
$39,259.24
|
| Rate for Payer: Cigna Commercial |
$65,170.34
|
| Rate for Payer: First Health Commercial |
$74,592.56
|
| Rate for Payer: Humana Commercial |
$66,740.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,385.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,946.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,555.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,096.26
|
| Rate for Payer: Ohio Health Group HMO |
$58,888.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,814.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,311.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,177.75
|
| Rate for Payer: PHCS Commercial |
$75,377.74
|
| Rate for Payer: United Healthcare All Payer |
$69,096.26
|
|
|
STEM FEM 12/14 135^ STD SZ 10
|
Facility
|
OP
|
$78,518.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,555.54 |
| Max. Negotiated Rate |
$75,377.74 |
| Rate for Payer: Aetna Commercial |
$60,459.23
|
| Rate for Payer: Anthem Medicaid |
$27,002.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,244.41
|
| Rate for Payer: Cash Price |
$39,259.24
|
| Rate for Payer: Cigna Commercial |
$65,170.34
|
| Rate for Payer: First Health Commercial |
$74,592.56
|
| Rate for Payer: Humana Commercial |
$66,740.71
|
| Rate for Payer: Humana KY Medicaid |
$27,002.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27,277.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,385.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,946.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,555.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,544.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,096.26
|
| Rate for Payer: Ohio Health Group HMO |
$58,888.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,814.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,311.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,177.75
|
| Rate for Payer: PHCS Commercial |
$75,377.74
|
| Rate for Payer: United Healthcare All Payer |
$69,096.26
|
|
|
STEM FEM 12/14 135^ STD SZ 11
|
Facility
|
OP
|
$78,518.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,555.54 |
| Max. Negotiated Rate |
$75,377.74 |
| Rate for Payer: Aetna Commercial |
$60,459.23
|
| Rate for Payer: Anthem Medicaid |
$27,002.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,244.41
|
| Rate for Payer: Cash Price |
$39,259.24
|
| Rate for Payer: Cigna Commercial |
$65,170.34
|
| Rate for Payer: First Health Commercial |
$74,592.56
|
| Rate for Payer: Humana Commercial |
$66,740.71
|
| Rate for Payer: Humana KY Medicaid |
$27,002.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27,277.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,385.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,946.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,555.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,544.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,096.26
|
| Rate for Payer: Ohio Health Group HMO |
$58,888.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,814.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,311.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,177.75
|
| Rate for Payer: PHCS Commercial |
$75,377.74
|
| Rate for Payer: United Healthcare All Payer |
$69,096.26
|
|
|
STEM FEM 12/14 135^ STD SZ 11
|
Facility
|
IP
|
$78,518.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,555.54 |
| Max. Negotiated Rate |
$75,377.74 |
| Rate for Payer: Aetna Commercial |
$60,459.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,244.41
|
| Rate for Payer: Cash Price |
$39,259.24
|
| Rate for Payer: Cigna Commercial |
$65,170.34
|
| Rate for Payer: First Health Commercial |
$74,592.56
|
| Rate for Payer: Humana Commercial |
$66,740.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,385.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,946.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,555.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,096.26
|
| Rate for Payer: Ohio Health Group HMO |
$58,888.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,814.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,311.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,177.75
|
| Rate for Payer: PHCS Commercial |
$75,377.74
|
| Rate for Payer: United Healthcare All Payer |
$69,096.26
|
|
|
STEM FEM 12/14 135^ STD SZ 12
|
Facility
|
IP
|
$78,518.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,555.54 |
| Max. Negotiated Rate |
$75,377.74 |
| Rate for Payer: Aetna Commercial |
$60,459.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,244.41
|
| Rate for Payer: Cash Price |
$39,259.24
|
| Rate for Payer: Cigna Commercial |
$65,170.34
|
| Rate for Payer: First Health Commercial |
$74,592.56
|
| Rate for Payer: Humana Commercial |
$66,740.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,385.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,946.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,555.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,096.26
|
| Rate for Payer: Ohio Health Group HMO |
$58,888.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,814.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,311.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,177.75
|
| Rate for Payer: PHCS Commercial |
$75,377.74
|
| Rate for Payer: United Healthcare All Payer |
$69,096.26
|
|
|
STEM FEM 12/14 135^ STD SZ 12
|
Facility
|
OP
|
$78,518.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,555.54 |
| Max. Negotiated Rate |
$75,377.74 |
| Rate for Payer: Aetna Commercial |
$60,459.23
|
| Rate for Payer: Anthem Medicaid |
$27,002.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,244.41
|
| Rate for Payer: Cash Price |
$39,259.24
|
| Rate for Payer: Cigna Commercial |
$65,170.34
|
| Rate for Payer: First Health Commercial |
$74,592.56
|
| Rate for Payer: Humana Commercial |
$66,740.71
|
| Rate for Payer: Humana KY Medicaid |
$27,002.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27,277.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,385.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,946.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,555.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,544.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,096.26
|
| Rate for Payer: Ohio Health Group HMO |
$58,888.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,814.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,311.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,177.75
|
| Rate for Payer: PHCS Commercial |
$75,377.74
|
| Rate for Payer: United Healthcare All Payer |
$69,096.26
|
|
|
STEM FEM 12/14 135^ STD SZ 13
|
Facility
|
OP
|
$88,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,486.94 |
| Max. Negotiated Rate |
$84,758.21 |
| Rate for Payer: Aetna Commercial |
$67,983.15
|
| Rate for Payer: Anthem Medicaid |
$30,362.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,866.04
|
| Rate for Payer: Cash Price |
$44,144.90
|
| Rate for Payer: Cigna Commercial |
$73,280.53
|
| Rate for Payer: First Health Commercial |
$83,875.31
|
| Rate for Payer: Humana Commercial |
$75,046.33
|
| Rate for Payer: Humana KY Medicaid |
$30,362.86
|
| Rate for Payer: Kentucky WC Medicaid |
$30,671.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,397.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,157.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,486.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,972.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,695.02
|
| Rate for Payer: Ohio Health Group HMO |
$66,217.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70,631.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76,812.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60,919.96
|
| Rate for Payer: PHCS Commercial |
$84,758.21
|
| Rate for Payer: United Healthcare All Payer |
$77,695.02
|
|
|
STEM FEM 12/14 135^ STD SZ 13
|
Facility
|
IP
|
$88,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,486.94 |
| Max. Negotiated Rate |
$84,758.21 |
| Rate for Payer: Aetna Commercial |
$67,983.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,866.04
|
| Rate for Payer: Cash Price |
$44,144.90
|
| Rate for Payer: Cigna Commercial |
$73,280.53
|
| Rate for Payer: First Health Commercial |
$83,875.31
|
| Rate for Payer: Humana Commercial |
$75,046.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,397.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,157.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,486.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,695.02
|
| Rate for Payer: Ohio Health Group HMO |
$66,217.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70,631.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76,812.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60,919.96
|
| Rate for Payer: PHCS Commercial |
$84,758.21
|
| Rate for Payer: United Healthcare All Payer |
$77,695.02
|
|
|
STEM FEM 12/14 PORO CAL 9IN L
|
Facility
|
OP
|
$91,911.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,573.36 |
| Max. Negotiated Rate |
$88,234.75 |
| Rate for Payer: Aetna Commercial |
$70,771.62
|
| Rate for Payer: Anthem Medicaid |
$31,608.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71,690.74
|
| Rate for Payer: Cash Price |
$45,955.60
|
| Rate for Payer: Cigna Commercial |
$76,286.30
|
| Rate for Payer: First Health Commercial |
$87,315.64
|
| Rate for Payer: Humana Commercial |
$78,124.52
|
| Rate for Payer: Humana KY Medicaid |
$31,608.26
|
| Rate for Payer: Kentucky WC Medicaid |
$31,929.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,367.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67,830.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,573.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,242.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$80,881.86
|
| Rate for Payer: Ohio Health Group HMO |
$68,933.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73,528.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79,962.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,418.73
|
| Rate for Payer: PHCS Commercial |
$88,234.75
|
| Rate for Payer: United Healthcare All Payer |
$80,881.86
|
|
|
STEM FEM 12/14 PORO CAL 9IN L
|
Facility
|
IP
|
$91,911.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,573.36 |
| Max. Negotiated Rate |
$88,234.75 |
| Rate for Payer: Aetna Commercial |
$70,771.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71,690.74
|
| Rate for Payer: Cash Price |
$45,955.60
|
| Rate for Payer: Cigna Commercial |
$76,286.30
|
| Rate for Payer: First Health Commercial |
$87,315.64
|
| Rate for Payer: Humana Commercial |
$78,124.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,367.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67,830.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,573.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$80,881.86
|
| Rate for Payer: Ohio Health Group HMO |
$68,933.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73,528.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79,962.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,418.73
|
| Rate for Payer: PHCS Commercial |
$88,234.75
|
| Rate for Payer: United Healthcare All Payer |
$80,881.86
|
|
|
STEM FEMORAL TPR 12/14 250MM
|
Facility
|
OP
|
$36,651.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,995.56 |
| Max. Negotiated Rate |
$35,185.80 |
| Rate for Payer: Aetna Commercial |
$28,221.95
|
| Rate for Payer: Anthem Medicaid |
$12,604.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,588.47
|
| Rate for Payer: Cash Price |
$18,325.94
|
| Rate for Payer: Cigna Commercial |
$30,421.06
|
| Rate for Payer: First Health Commercial |
$34,819.29
|
| Rate for Payer: Humana Commercial |
$31,154.10
|
| Rate for Payer: Humana KY Medicaid |
$12,604.58
|
| Rate for Payer: Kentucky WC Medicaid |
$12,732.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,054.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,049.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,995.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,857.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,253.65
|
| Rate for Payer: Ohio Health Group HMO |
$27,488.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,321.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,887.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,289.80
|
| Rate for Payer: PHCS Commercial |
$35,185.80
|
| Rate for Payer: United Healthcare All Payer |
$32,253.65
|
|
|
STEM FEMORAL TPR 12/14 250MM
|
Facility
|
IP
|
$36,651.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,995.56 |
| Max. Negotiated Rate |
$35,185.80 |
| Rate for Payer: Aetna Commercial |
$28,221.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,588.47
|
| Rate for Payer: Cash Price |
$18,325.94
|
| Rate for Payer: Cigna Commercial |
$30,421.06
|
| Rate for Payer: First Health Commercial |
$34,819.29
|
| Rate for Payer: Humana Commercial |
$31,154.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,054.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,049.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,995.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,253.65
|
| Rate for Payer: Ohio Health Group HMO |
$27,488.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,321.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,887.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,289.80
|
| Rate for Payer: PHCS Commercial |
$35,185.80
|
| Rate for Payer: United Healthcare All Payer |
$32,253.65
|
|
|
STEM FLUTE PS EXT 20X120MM
|
Facility
|
IP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
|
STEM FLUTE PS EXT 20X120MM
|
Facility
|
OP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem Medicaid |
$3,108.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Humana KY Medicaid |
$3,108.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,139.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,170.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
|
STEM FLUTE PS EXT 20X160MM
|
Facility
|
IP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
|
STEM FLUTE PS EXT 20X160MM
|
Facility
|
OP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem Medicaid |
$3,108.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Humana KY Medicaid |
$3,108.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,139.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,170.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
|
STEM FLUTE PS EXT 22X120MM
|
Facility
|
OP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem Medicaid |
$3,108.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Humana KY Medicaid |
$3,108.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,139.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,170.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
|
STEM FLUTE PS EXT 22X120MM
|
Facility
|
IP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
|
STEM FLUTE PS EXT 22X160MM
|
Facility
|
IP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
|
STEM FLUTE PS EXT 22X160MM
|
Facility
|
OP
|
$9,038.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.40 |
| Max. Negotiated Rate |
$8,676.49 |
| Rate for Payer: Aetna Commercial |
$6,959.27
|
| Rate for Payer: Anthem Medicaid |
$3,108.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,049.65
|
| Rate for Payer: Cash Price |
$4,519.01
|
| Rate for Payer: Cigna Commercial |
$7,501.55
|
| Rate for Payer: First Health Commercial |
$8,586.11
|
| Rate for Payer: Humana Commercial |
$7,682.31
|
| Rate for Payer: Humana KY Medicaid |
$3,108.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,139.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,170.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,953.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,778.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,230.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.23
|
| Rate for Payer: PHCS Commercial |
$8,676.49
|
| Rate for Payer: United Healthcare All Payer |
$7,953.45
|
|
