|
STEM PF EXT FLT 14MMX160MM
|
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 15MMX120MM
|
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 15MMX120MM
|
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 15MMX160MM
|
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 15MMX160MM
|
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 16MMX120MM
|
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 16MMX120MM
|
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 16MMX160MM
|
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 16MMX160MM
|
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 18MMX120MM
|
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 18MMX120MM
|
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 18MMX160MM
|
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 18MMX160MM
|
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 POROUS OSS IM 10.5X90
|
Facility
|
OP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem Medicaid |
$5,806.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Humana KY Medicaid |
$5,806.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,865.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,923.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 10.5X90
|
Facility
|
IP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 11.5X90
|
Facility
|
IP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 11.5X90
|
Facility
|
OP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem Medicaid |
$5,806.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Humana KY Medicaid |
$5,806.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,865.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,923.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X150
|
Facility
|
OP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem Medicaid |
$5,806.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Humana KY Medicaid |
$5,806.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,865.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,923.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X150
|
Facility
|
IP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X225
|
Facility
|
IP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X225
|
Facility
|
OP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem Medicaid |
$5,806.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Humana KY Medicaid |
$5,806.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,865.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,923.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X300
|
Facility
|
IP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X300
|
Facility
|
OP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem Medicaid |
$5,806.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Humana KY Medicaid |
$5,806.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,865.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,923.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X90
|
Facility
|
OP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem Medicaid |
$5,806.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Humana KY Medicaid |
$5,806.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,865.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,923.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
|
STEM POROUS OSS IM 12.5X90
|
Facility
|
IP
|
$16,885.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,065.58 |
| Max. Negotiated Rate |
$16,209.87 |
| Rate for Payer: Aetna Commercial |
$13,001.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,170.52
|
| Rate for Payer: Cash Price |
$8,442.64
|
| Rate for Payer: Cigna Commercial |
$14,014.78
|
| Rate for Payer: First Health Commercial |
$16,041.02
|
| Rate for Payer: Humana Commercial |
$14,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,845.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,461.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,065.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,859.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,508.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,690.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,650.84
|
| Rate for Payer: PHCS Commercial |
$16,209.87
|
| Rate for Payer: United Healthcare All Payer |
$14,859.05
|
|
