|
STEM NXGN STRGHT EXT 18X200MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 20X145MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 20X145MM
|
Facility
|
OP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem Medicaid |
$2,436.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Humana KY Medicaid |
$2,436.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 22X145MM
|
Facility
|
OP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem Medicaid |
$2,436.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Humana KY Medicaid |
$2,436.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 22X145MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 24X145MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM NXGN STRGHT EXT 24X145MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM OFFSET SUPER HIGH SZ 12
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 12
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 13
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 13
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 14
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 14
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 15
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 15
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 16
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OFFSET SUPER HIGH SZ 16
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
STEM OMNIFIT CEMENT #11 200L
|
Facility
|
OP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem Medicaid |
$6,229.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Humana KY Medicaid |
$6,229.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,292.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,354.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
|
STEM OMNIFIT CEMENT #11 200L
|
Facility
|
IP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
|
STEM OMNIFIT CEMENT #11 200R
|
Facility
|
IP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
|
STEM OMNIFIT CEMENT #11 200R
|
Facility
|
OP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem Medicaid |
$6,229.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Humana KY Medicaid |
$6,229.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,292.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,354.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
|
STEM OMNIFIT CEMENT #11 250L
|
Facility
|
OP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem Medicaid |
$6,229.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Humana KY Medicaid |
$6,229.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,292.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,354.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
|
STEM OMNIFIT CEMENT #11 250L
|
Facility
|
IP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
|
STEM OMNIFIT CEMENT #11 250R
|
Facility
|
IP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
|
STEM OMNIFIT CEMENT #11 250R
|
Facility
|
OP
|
$18,113.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.10 |
| Max. Negotiated Rate |
$17,389.13 |
| Rate for Payer: Aetna Commercial |
$13,947.53
|
| Rate for Payer: Anthem Medicaid |
$6,229.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.67
|
| Rate for Payer: Cash Price |
$9,056.84
|
| Rate for Payer: Cigna Commercial |
$15,034.35
|
| Rate for Payer: First Health Commercial |
$17,208.00
|
| Rate for Payer: Humana Commercial |
$15,396.63
|
| Rate for Payer: Humana KY Medicaid |
$6,229.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,292.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,853.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,434.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,354.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,940.04
|
| Rate for Payer: Ohio Health Group HMO |
$13,585.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,490.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,758.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,498.44
|
| Rate for Payer: PHCS Commercial |
$17,389.13
|
| Rate for Payer: United Healthcare All Payer |
$15,940.04
|
|
