|
STEM OMNIFIT CEMENT #9 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 #9 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 #9 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 #9 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 #9 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 #9 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 PF EXT FLT 10MMX120MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 10MMX120MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 10MMX160MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 10MMX160MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 11MMX120MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 11MMX120MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 11MMX160MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 11MMX160MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 12MMX120MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 12MMX120MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 12MMX160MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 12MMX160MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 13MMX120MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 13MMX120MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 13MMX160MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 13MMX160MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 14MMX120MM
|
Facility
|
OP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem Medicaid |
$3,246.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Humana KY Medicaid |
$3,246.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,312.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 14MMX120MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
|
STEM PF EXT FLT 14MMX160MM
|
Facility
|
IP
|
$9,441.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.40 |
| Max. Negotiated Rate |
$9,063.69 |
| Rate for Payer: Aetna Commercial |
$7,269.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,364.25
|
| Rate for Payer: Cash Price |
$4,720.67
|
| Rate for Payer: Cigna Commercial |
$7,836.31
|
| Rate for Payer: First Health Commercial |
$8,969.27
|
| Rate for Payer: Humana Commercial |
$8,025.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,741.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,967.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,832.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,308.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,081.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,553.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,213.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,514.52
|
| Rate for Payer: PHCS Commercial |
$9,063.69
|
| Rate for Payer: United Healthcare All Payer |
$8,308.38
|
|
