|
STEM POROUS OSS IM 17.5X150
|
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 17.5X90
|
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 17.5X90
|
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 18.5X150
|
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 18.5X150
|
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 18.5X225
|
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 18.5X225
|
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 18.5X300
|
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 18.5X300
|
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 18.5X90
|
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 18.5X90
|
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 19.5X150
|
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 19.5X150
|
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 19.5X90
|
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 19.5X90
|
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 20.5X150
|
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 20.5X150
|
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 21.5X150
|
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 21.5X150
|
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 22.5X150
|
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 22.5X150
|
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 POR PROX TIB OSS 12.5*150
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM POR PROX TIB OSS 12.5*150
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM POR PROX TIB OSS 14.5*150
|
Facility
|
OP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem Medicaid |
$5,394.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Humana KY Medicaid |
$5,394.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,449.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,502.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
|
STEM POR PROX TIB OSS 14.5*150
|
Facility
|
IP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
