|
STEM MONO SLVLS SO SZ24 240MM
|
Facility
|
OP
|
$37,714.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,314.33 |
| Max. Negotiated Rate |
$36,205.86 |
| Rate for Payer: Aetna Commercial |
$29,040.12
|
| Rate for Payer: Anthem Medicaid |
$12,970.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,417.26
|
| Rate for Payer: Cash Price |
$18,857.22
|
| Rate for Payer: Cigna Commercial |
$31,302.99
|
| Rate for Payer: First Health Commercial |
$35,828.72
|
| Rate for Payer: Humana Commercial |
$32,057.27
|
| Rate for Payer: Humana KY Medicaid |
$12,970.00
|
| Rate for Payer: Kentucky WC Medicaid |
$13,102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,925.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,833.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,314.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,230.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,188.71
|
| Rate for Payer: Ohio Health Group HMO |
$28,285.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,171.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,811.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,022.96
|
| Rate for Payer: PHCS Commercial |
$36,205.86
|
| Rate for Payer: United Healthcare All Payer |
$33,188.71
|
|
|
STEM MONO SLVLS SO SZ24 300MM
|
Facility
|
IP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM MONO SLVLS SO SZ24 300MM
|
Facility
|
OP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem Medicaid |
$13,583.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Humana KY Medicaid |
$13,583.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13,722.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,856.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM MONO SLVLS SO SZ25 240MM
|
Facility
|
OP
|
$37,714.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,314.22 |
| Max. Negotiated Rate |
$36,205.50 |
| Rate for Payer: Aetna Commercial |
$29,039.83
|
| Rate for Payer: Anthem Medicaid |
$12,969.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,416.97
|
| Rate for Payer: Cash Price |
$18,857.03
|
| Rate for Payer: Cigna Commercial |
$31,302.67
|
| Rate for Payer: First Health Commercial |
$35,828.36
|
| Rate for Payer: Humana Commercial |
$32,056.95
|
| Rate for Payer: Humana KY Medicaid |
$12,969.87
|
| Rate for Payer: Kentucky WC Medicaid |
$13,101.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,925.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,832.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,314.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,230.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,188.37
|
| Rate for Payer: Ohio Health Group HMO |
$28,285.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,171.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,811.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,022.70
|
| Rate for Payer: PHCS Commercial |
$36,205.50
|
| Rate for Payer: United Healthcare All Payer |
$33,188.37
|
|
|
STEM MONO SLVLS SO SZ25 240MM
|
Facility
|
IP
|
$37,714.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,314.22 |
| Max. Negotiated Rate |
$36,205.50 |
| Rate for Payer: Aetna Commercial |
$29,039.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,416.97
|
| Rate for Payer: Cash Price |
$18,857.03
|
| Rate for Payer: Cigna Commercial |
$31,302.67
|
| Rate for Payer: First Health Commercial |
$35,828.36
|
| Rate for Payer: Humana Commercial |
$32,056.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,925.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,832.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,314.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,188.37
|
| Rate for Payer: Ohio Health Group HMO |
$28,285.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,171.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,811.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,022.70
|
| Rate for Payer: PHCS Commercial |
$36,205.50
|
| Rate for Payer: United Healthcare All Payer |
$33,188.37
|
|
|
STEM MONO SLVLS SO SZ25 300MM
|
Facility
|
IP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM MONO SLVLS SO SZ25 300MM
|
Facility
|
OP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem Medicaid |
$13,583.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Humana KY Medicaid |
$13,583.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13,722.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,856.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM MONO SLVLS SO SZ26 240MM
|
Facility
|
IP
|
$37,714.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,314.22 |
| Max. Negotiated Rate |
$36,205.50 |
| Rate for Payer: Aetna Commercial |
$29,039.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,416.97
|
| Rate for Payer: Cash Price |
$18,857.03
|
| Rate for Payer: Cigna Commercial |
$31,302.67
|
| Rate for Payer: First Health Commercial |
$35,828.36
|
| Rate for Payer: Humana Commercial |
$32,056.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,925.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,832.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,314.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,188.37
|
| Rate for Payer: Ohio Health Group HMO |
$28,285.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,171.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,811.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,022.70
|
| Rate for Payer: PHCS Commercial |
$36,205.50
|
| Rate for Payer: United Healthcare All Payer |
$33,188.37
|
|
|
STEM MONO SLVLS SO SZ26 240MM
|
Facility
|
OP
|
$37,714.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,314.22 |
| Max. Negotiated Rate |
$36,205.50 |
| Rate for Payer: Aetna Commercial |
$29,039.83
|
| Rate for Payer: Anthem Medicaid |
$12,969.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,416.97
|
| Rate for Payer: Cash Price |
$18,857.03
|
| Rate for Payer: Cigna Commercial |
$31,302.67
|
| Rate for Payer: First Health Commercial |
$35,828.36
|
| Rate for Payer: Humana Commercial |
$32,056.95
|
| Rate for Payer: Humana KY Medicaid |
$12,969.87
|
| Rate for Payer: Kentucky WC Medicaid |
$13,101.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,925.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,832.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,314.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,230.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,188.37
|
| Rate for Payer: Ohio Health Group HMO |
$28,285.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,171.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,811.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,022.70
|
| Rate for Payer: PHCS Commercial |
$36,205.50
|
| Rate for Payer: United Healthcare All Payer |
$33,188.37
|
|
|
STEM MONO SLVLS SO SZ26 300MM
|
Facility
|
OP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem Medicaid |
$13,583.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Humana KY Medicaid |
$13,583.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13,722.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,856.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM MONO SLVLS SO SZ26 300MM
|
Facility
|
IP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM MONO SLVLS SO SZ27 240MM
|
Facility
|
OP
|
$37,714.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,314.33 |
| Max. Negotiated Rate |
$36,205.86 |
| Rate for Payer: Aetna Commercial |
$29,040.12
|
| Rate for Payer: Anthem Medicaid |
$12,970.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,417.26
|
| Rate for Payer: Cash Price |
$18,857.22
|
| Rate for Payer: Cigna Commercial |
$31,302.99
|
| Rate for Payer: First Health Commercial |
$35,828.72
|
| Rate for Payer: Humana Commercial |
$32,057.27
|
| Rate for Payer: Humana KY Medicaid |
$12,970.00
|
| Rate for Payer: Kentucky WC Medicaid |
$13,102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,925.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,833.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,314.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,230.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,188.71
|
| Rate for Payer: Ohio Health Group HMO |
$28,285.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,171.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,811.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,022.96
|
| Rate for Payer: PHCS Commercial |
$36,205.86
|
| Rate for Payer: United Healthcare All Payer |
$33,188.71
|
|
|
STEM MONO SLVLS SO SZ27 240MM
|
Facility
|
IP
|
$37,714.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,314.33 |
| Max. Negotiated Rate |
$36,205.86 |
| Rate for Payer: Aetna Commercial |
$29,040.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,417.26
|
| Rate for Payer: Cash Price |
$18,857.22
|
| Rate for Payer: Cigna Commercial |
$31,302.99
|
| Rate for Payer: First Health Commercial |
$35,828.72
|
| Rate for Payer: Humana Commercial |
$32,057.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,925.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,833.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,314.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,188.71
|
| Rate for Payer: Ohio Health Group HMO |
$28,285.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,171.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,811.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,022.96
|
| Rate for Payer: PHCS Commercial |
$36,205.86
|
| Rate for Payer: United Healthcare All Payer |
$33,188.71
|
|
|
STEM MONO SLVLS SO SZ27 300MM
|
Facility
|
IP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM MONO SLVLS SO SZ27 300MM
|
Facility
|
OP
|
$39,499.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,849.77 |
| Max. Negotiated Rate |
$37,919.28 |
| Rate for Payer: Aetna Commercial |
$30,414.42
|
| Rate for Payer: Anthem Medicaid |
$13,583.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,809.42
|
| Rate for Payer: Cash Price |
$19,749.62
|
| Rate for Payer: Cigna Commercial |
$32,784.38
|
| Rate for Payer: First Health Commercial |
$37,524.29
|
| Rate for Payer: Humana Commercial |
$33,574.36
|
| Rate for Payer: Humana KY Medicaid |
$13,583.79
|
| Rate for Payer: Kentucky WC Medicaid |
$13,722.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,389.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,150.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,849.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,856.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$29,624.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,599.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,364.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,254.48
|
| Rate for Payer: PHCS Commercial |
$37,919.28
|
| Rate for Payer: United Healthcare All Payer |
$34,759.34
|
|
|
STEM NEXGEN CEMENTED 13*105*60
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN CEMENTED 13*105*60
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN CEMENTED 13*75*30
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN CEMENTED 13*75*30
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 10X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 10X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 11X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 11X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 12X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 12X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
