|
STEM LPS POROUS 15.5*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 16.5*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 16.5*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 17.5*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 17.5*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 18.5*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 18.5*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 MODULAR FLUTED 40MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM MODULAR FLUTED 40MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM MONO SLVD HO SZ12 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ12 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ13 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ13 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ14 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ14 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ15 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ15 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ16 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ16 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ17 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ17 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ18 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ18 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ19 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ19 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
