|
STEM REJUVENATE MOD SZ 9
|
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 9
|
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 MONO 127^ SZ 6
|
Facility
|
OP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem Medicaid |
$7,329.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Humana KY Medicaid |
$7,329.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,403.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,476.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REJUVENATE MONO 127^ SZ 6
|
Facility
|
IP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REJUVENATE MONO 132^ SZ 4
|
Facility
|
OP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem Medicaid |
$7,329.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Humana KY Medicaid |
$7,329.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,403.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,476.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REJUVENATE MONO 132^ SZ 4
|
Facility
|
IP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REJUVENATE MONO 132^ SZ 5
|
Facility
|
IP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REJUVENATE MONO 132^ SZ 5
|
Facility
|
OP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem Medicaid |
$7,329.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Humana KY Medicaid |
$7,329.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,403.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,476.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REJUVENATE MONO 132^ SZ 6
|
Facility
|
IP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REJUVENATE MONO 132^ SZ 6
|
Facility
|
OP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem Medicaid |
$7,329.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Humana KY Medicaid |
$7,329.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,403.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,476.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
STEM REV 3D COATED SZ 10
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 10
|
Facility
|
IP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 11
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM REV 3D COATED SZ 11
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM REV 3D COATED SZ 12
|
Facility
|
IP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 12
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 13
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM REV 3D COATED SZ 13
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM REV 3D COATED SZ 14
|
Facility
|
IP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 14
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 15
|
Facility
|
IP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 15
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 5
|
Facility
|
IP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 5
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM REV 3D COATED SZ 6
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
