|
STEM POROUS OSS IM 13.5X150
|
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 13.5X150
|
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 13.5X90
|
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 13.5X90
|
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 14.5X150
|
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 14.5X150
|
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 14.5X225
|
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 14.5X225
|
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 14.5X300
|
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 14.5X300
|
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 14.5X90
|
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 14.5X90
|
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 15.5X150
|
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 15.5X150
|
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 15.5X90
|
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 15.5X90
|
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 16.5X150
|
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 16.5X150
|
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 16.5X225
|
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 16.5X225
|
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 16.5X300
|
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 16.5X300
|
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 16.5X90
|
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 16.5X90
|
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 17.5X150
|
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
|
|
