|
STEM FLUTE PS EXT 24X120MM
|
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 24X120MM
|
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 24X160MM
|
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 24X160MM
|
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 GMRS LG BOWED PF 13*200MM
|
Facility
|
IP
|
$23,732.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,119.60 |
| Max. Negotiated Rate |
$22,782.72 |
| Rate for Payer: Aetna Commercial |
$18,273.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.96
|
| Rate for Payer: Cash Price |
$11,866.00
|
| Rate for Payer: Cigna Commercial |
$19,697.56
|
| Rate for Payer: First Health Commercial |
$22,545.40
|
| Rate for Payer: Humana Commercial |
$20,172.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,460.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,514.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,884.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,799.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,375.08
|
| Rate for Payer: PHCS Commercial |
$22,782.72
|
| Rate for Payer: United Healthcare All Payer |
$20,884.16
|
|
|
STEM GMRS LG BOWED PF 13*200MM
|
Facility
|
OP
|
$23,732.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,119.60 |
| Max. Negotiated Rate |
$22,782.72 |
| Rate for Payer: Aetna Commercial |
$18,273.64
|
| Rate for Payer: Anthem Medicaid |
$8,161.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.96
|
| Rate for Payer: Cash Price |
$11,866.00
|
| Rate for Payer: Cigna Commercial |
$19,697.56
|
| Rate for Payer: First Health Commercial |
$22,545.40
|
| Rate for Payer: Humana Commercial |
$20,172.20
|
| Rate for Payer: Humana KY Medicaid |
$8,161.43
|
| Rate for Payer: Kentucky WC Medicaid |
$8,244.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,460.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,514.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,884.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,799.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,375.08
|
| Rate for Payer: PHCS Commercial |
$22,782.72
|
| Rate for Payer: United Healthcare All Payer |
$20,884.16
|
|
|
STEM GMRS LG BOWED PF 15*200MM
|
Facility
|
OP
|
$23,732.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,119.60 |
| Max. Negotiated Rate |
$22,782.72 |
| Rate for Payer: Aetna Commercial |
$18,273.64
|
| Rate for Payer: Anthem Medicaid |
$8,161.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.96
|
| Rate for Payer: Cash Price |
$11,866.00
|
| Rate for Payer: Cigna Commercial |
$19,697.56
|
| Rate for Payer: First Health Commercial |
$22,545.40
|
| Rate for Payer: Humana Commercial |
$20,172.20
|
| Rate for Payer: Humana KY Medicaid |
$8,161.43
|
| Rate for Payer: Kentucky WC Medicaid |
$8,244.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,460.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,514.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,884.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,799.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,375.08
|
| Rate for Payer: PHCS Commercial |
$22,782.72
|
| Rate for Payer: United Healthcare All Payer |
$20,884.16
|
|
|
STEM GMRS LG BOWED PF 15*200MM
|
Facility
|
IP
|
$23,732.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,119.60 |
| Max. Negotiated Rate |
$22,782.72 |
| Rate for Payer: Aetna Commercial |
$18,273.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.96
|
| Rate for Payer: Cash Price |
$11,866.00
|
| Rate for Payer: Cigna Commercial |
$19,697.56
|
| Rate for Payer: First Health Commercial |
$22,545.40
|
| Rate for Payer: Humana Commercial |
$20,172.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,460.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,514.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,884.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,799.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,375.08
|
| Rate for Payer: PHCS Commercial |
$22,782.72
|
| Rate for Payer: United Healthcare All Payer |
$20,884.16
|
|
|
STEM GRIT BLAST PS 20X160
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM GRIT BLAST PS 20X160
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM HIP 14/225 TAP12/14
|
Facility
|
OP
|
$28,152.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,445.85 |
| Max. Negotiated Rate |
$27,026.73 |
| Rate for Payer: Aetna Commercial |
$21,677.69
|
| Rate for Payer: Anthem Medicaid |
$9,681.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,959.22
|
| Rate for Payer: Cash Price |
$14,076.42
|
| Rate for Payer: Cigna Commercial |
$23,366.86
|
| Rate for Payer: First Health Commercial |
$26,745.20
|
| Rate for Payer: Humana Commercial |
$23,929.91
|
| Rate for Payer: Humana KY Medicaid |
$9,681.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,780.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,085.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,776.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,445.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,876.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,774.50
|
| Rate for Payer: Ohio Health Group HMO |
$21,114.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,522.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,492.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,425.46
|
| Rate for Payer: PHCS Commercial |
$27,026.73
|
| Rate for Payer: United Healthcare All Payer |
$24,774.50
|
|
|
STEM HIP 14/225 TAP12/14
|
Facility
|
IP
|
$28,152.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,445.85 |
| Max. Negotiated Rate |
$27,026.73 |
| Rate for Payer: Aetna Commercial |
$21,677.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,959.22
|
| Rate for Payer: Cash Price |
$14,076.42
|
| Rate for Payer: Cigna Commercial |
$23,366.86
|
| Rate for Payer: First Health Commercial |
$26,745.20
|
| Rate for Payer: Humana Commercial |
$23,929.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,085.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,776.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,445.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,774.50
|
| Rate for Payer: Ohio Health Group HMO |
$21,114.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,522.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,492.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,425.46
|
| Rate for Payer: PHCS Commercial |
$27,026.73
|
| Rate for Payer: United Healthcare All Payer |
$24,774.50
|
|
|
STEM HIP ANG 132^ 25MM*120MM #
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP ANG 132^ 25MM*120MM #
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP ANG 132^ 30MM*130MM #
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP ANG 132^ 30MM*130MM #
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP ANG 132^ 30MM*140MM #
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP ANG 132^ 30MM*140MM #
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP ANG 132^ 40MM*170MM
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP ANG 132^ 40MM*170MM
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIPANG 132^40MM*170MM #12
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIPANG 132^40MM*170MM #12
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM HIP OFFSET 3 32.5*101MM
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM HIP OFFSET 3 32.5*101MM
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM HIP OFFSET 8 38*111MM
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
