|
STEM REINFRCD HIPMOLD 11X200MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 13X145MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 13X145MM
|
Facility
|
OP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Humana KY Medicaid |
$3,481.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,551.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 13X200MM
|
Facility
|
OP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Humana KY Medicaid |
$3,481.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,551.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 13X200MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 15X155MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 15X155MM
|
Facility
|
OP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Humana KY Medicaid |
$3,481.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,551.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 15X200MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 15X200MM
|
Facility
|
OP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Humana KY Medicaid |
$3,481.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,551.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 17X165MM
|
Facility
|
OP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Humana KY Medicaid |
$3,481.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,551.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 17X165MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 17X200MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIPMOLD 17X200MM
|
Facility
|
OP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Humana KY Medicaid |
$3,481.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,551.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIP MOLD 9X200MM
|
Facility
|
OP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Humana KY Medicaid |
$3,481.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,551.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REINFRCD HIP MOLD 9X200MM
|
Facility
|
IP
|
$10,124.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.44 |
| Max. Negotiated Rate |
$9,719.81 |
| Rate for Payer: Aetna Commercial |
$7,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,897.34
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cigna Commercial |
$8,403.58
|
| Rate for Payer: First Health Commercial |
$9,618.56
|
| Rate for Payer: Humana Commercial |
$8,606.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,302.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,472.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,037.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,909.82
|
| Rate for Payer: Ohio Health Group HMO |
$7,593.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,099.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,808.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,986.11
|
| Rate for Payer: PHCS Commercial |
$9,719.81
|
| Rate for Payer: United Healthcare All Payer |
$8,909.82
|
|
|
STEM REJUVENATE MOD SZ 10
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 10
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 11
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 11
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 12
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 12
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 7
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 7
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 8
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM REJUVENATE MOD SZ 8
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
