|
STEM LPS PC FEM 15.5*150MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 15.5*150MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 16.5*150MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 16.5*150MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 16.5*200MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 16.5*200MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 17.5*150MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 17.5*150MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 18.5*150MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 18.5*150MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 18.5*200MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 18.5*200MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS POROUS 10.5*100MM STR
|
Facility
|
OP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem Medicaid |
$8,531.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Humana KY Medicaid |
$8,531.20
|
| Rate for Payer: Kentucky WC Medicaid |
$8,618.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,702.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 10.5*100MM STR
|
Facility
|
IP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 11.5*100MM STR
|
Facility
|
OP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem Medicaid |
$8,531.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Humana KY Medicaid |
$8,531.20
|
| Rate for Payer: Kentucky WC Medicaid |
$8,618.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,702.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 11.5*100MM STR
|
Facility
|
IP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 12.5*100MM STR
|
Facility
|
IP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 12.5*100MM STR
|
Facility
|
OP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem Medicaid |
$8,531.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Humana KY Medicaid |
$8,531.20
|
| Rate for Payer: Kentucky WC Medicaid |
$8,618.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,702.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 13.5*100MM STR
|
Facility
|
IP
|
$27,704.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,311.37 |
| Max. Negotiated Rate |
$26,596.38 |
| Rate for Payer: Aetna Commercial |
$21,332.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,609.56
|
| Rate for Payer: Cash Price |
$13,852.28
|
| Rate for Payer: Cigna Commercial |
$22,994.78
|
| Rate for Payer: First Health Commercial |
$26,319.33
|
| Rate for Payer: Humana Commercial |
$23,548.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,717.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,445.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,311.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,380.01
|
| Rate for Payer: Ohio Health Group HMO |
$20,778.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,163.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,102.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,116.15
|
| Rate for Payer: PHCS Commercial |
$26,596.38
|
| Rate for Payer: United Healthcare All Payer |
$24,380.01
|
|
|
STEM LPS POROUS 13.5*100MM STR
|
Facility
|
OP
|
$27,704.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,311.37 |
| Max. Negotiated Rate |
$26,596.38 |
| Rate for Payer: Aetna Commercial |
$21,332.51
|
| Rate for Payer: Anthem Medicaid |
$9,527.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,609.56
|
| Rate for Payer: Cash Price |
$13,852.28
|
| Rate for Payer: Cigna Commercial |
$22,994.78
|
| Rate for Payer: First Health Commercial |
$26,319.33
|
| Rate for Payer: Humana Commercial |
$23,548.88
|
| Rate for Payer: Humana KY Medicaid |
$9,527.60
|
| Rate for Payer: Kentucky WC Medicaid |
$9,624.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,717.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,445.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,311.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,718.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,380.01
|
| Rate for Payer: Ohio Health Group HMO |
$20,778.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,163.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,102.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,116.15
|
| Rate for Payer: PHCS Commercial |
$26,596.38
|
| Rate for Payer: United Healthcare All Payer |
$24,380.01
|
|
|
STEM LPS POROUS 13.5*125MM STR
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS POROUS 13.5*125MM STR
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS POROUS 14.5*125MM STR
|
Facility
|
OP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem Medicaid |
$8,531.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Humana KY Medicaid |
$8,531.20
|
| Rate for Payer: Kentucky WC Medicaid |
$8,618.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,702.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 14.5*125MM STR
|
Facility
|
IP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
|
STEM LPS POROUS 15.5*125MM STR
|
Facility
|
IP
|
$24,807.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,442.16 |
| Max. Negotiated Rate |
$23,814.91 |
| Rate for Payer: Aetna Commercial |
$19,101.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,349.62
|
| Rate for Payer: Cash Price |
$12,403.60
|
| Rate for Payer: Cigna Commercial |
$20,589.98
|
| Rate for Payer: First Health Commercial |
$23,566.84
|
| Rate for Payer: Humana Commercial |
$21,086.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,341.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,307.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,442.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,830.34
|
| Rate for Payer: Ohio Health Group HMO |
$18,605.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,845.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,582.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,116.97
|
| Rate for Payer: PHCS Commercial |
$23,814.91
|
| Rate for Payer: United Healthcare All Payer |
$21,830.34
|
|
