|
STEM HUMERAL APEX SIZE 7
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUMERAL APEX SIZE 7
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUMERAL FRACT 12*128
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
STEM HUMERAL FRACT 12*128
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
STEM HUMERAL REVERS SIZE 7
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUMERAL REVERS SIZE 7
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUMERAL REV SIZE 9
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUMERAL REV SIZE 9
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUMERAL SZ 13 P
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUMERAL SZ 13 P
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM HUM W/ POROCOAT SZ 6MM
|
Facility
|
OP
|
$22,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,616.50 |
| Max. Negotiated Rate |
$21,172.80 |
| Rate for Payer: Aetna Commercial |
$16,982.35
|
| Rate for Payer: Anthem Medicaid |
$7,584.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,202.90
|
| Rate for Payer: Cash Price |
$11,027.50
|
| Rate for Payer: Cigna Commercial |
$18,305.65
|
| Rate for Payer: First Health Commercial |
$20,952.25
|
| Rate for Payer: Humana Commercial |
$18,746.75
|
| Rate for Payer: Humana KY Medicaid |
$7,584.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,661.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,085.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,276.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,616.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,736.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,408.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,541.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,217.95
|
| Rate for Payer: PHCS Commercial |
$21,172.80
|
| Rate for Payer: United Healthcare All Payer |
$19,408.40
|
|
|
STEM HUM W/ POROCOAT SZ 6MM
|
Facility
|
IP
|
$22,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,616.50 |
| Max. Negotiated Rate |
$21,172.80 |
| Rate for Payer: Aetna Commercial |
$16,982.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,202.90
|
| Rate for Payer: Cash Price |
$11,027.50
|
| Rate for Payer: Cigna Commercial |
$18,305.65
|
| Rate for Payer: First Health Commercial |
$20,952.25
|
| Rate for Payer: Humana Commercial |
$18,746.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,085.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,276.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,616.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,408.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,541.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,217.95
|
| Rate for Payer: PHCS Commercial |
$21,172.80
|
| Rate for Payer: United Healthcare All Payer |
$19,408.40
|
|
|
STEM ILOK TIB TRAY 83MM
|
Facility
|
IP
|
$18,021.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,406.58 |
| Max. Negotiated Rate |
$17,301.04 |
| Rate for Payer: Aetna Commercial |
$13,876.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,057.10
|
| Rate for Payer: Cash Price |
$9,010.96
|
| Rate for Payer: Cigna Commercial |
$14,958.19
|
| Rate for Payer: First Health Commercial |
$17,120.82
|
| Rate for Payer: Humana Commercial |
$15,318.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,777.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,300.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,406.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,859.29
|
| Rate for Payer: Ohio Health Group HMO |
$13,516.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,417.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,679.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,435.12
|
| Rate for Payer: PHCS Commercial |
$17,301.04
|
| Rate for Payer: United Healthcare All Payer |
$15,859.29
|
|
|
STEM ILOK TIB TRAY 83MM
|
Facility
|
OP
|
$18,021.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,406.58 |
| Max. Negotiated Rate |
$17,301.04 |
| Rate for Payer: Aetna Commercial |
$13,876.88
|
| Rate for Payer: Anthem Medicaid |
$6,197.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,057.10
|
| Rate for Payer: Cash Price |
$9,010.96
|
| Rate for Payer: Cigna Commercial |
$14,958.19
|
| Rate for Payer: First Health Commercial |
$17,120.82
|
| Rate for Payer: Humana Commercial |
$15,318.63
|
| Rate for Payer: Humana KY Medicaid |
$6,197.74
|
| Rate for Payer: Kentucky WC Medicaid |
$6,260.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,777.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,300.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,406.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,322.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,859.29
|
| Rate for Payer: Ohio Health Group HMO |
$13,516.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,417.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,679.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,435.12
|
| Rate for Payer: PHCS Commercial |
$17,301.04
|
| Rate for Payer: United Healthcare All Payer |
$15,859.29
|
|
|
STEM IMPACTOR ROD
|
Facility
|
IP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
STEM IMPACTOR ROD
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 1
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 1
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 2
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 2
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 3
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 3
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 4
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 4
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS LATTI/HA 5
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
