|
STEM OMNIFIT CEMENT #11 300L
|
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 300L
|
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 300R
|
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 300R
|
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 350L
|
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 350L
|
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 350R
|
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 350R
|
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 #5 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 #5 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 #5 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 #5 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 #5 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 #5 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 #5 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
|
|
|
STEM OMNIFIT CEMENT #5 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 #5 300L
|
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 #5 300L
|
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 #5 300R
|
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 #5 300R
|
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 #5 350L
|
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 #5 350L
|
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 #5 350R
|
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 #5 350R
|
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 #7 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
|
|
