|
STEM REV 3D COATED SZ 6
|
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 7
|
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 7
|
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 8
|
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 8
|
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 9
|
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 9
|
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 APEX COATED SZ 11
|
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 APEX COATED SZ 11
|
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 REVER REVIS SZ 12*180
|
Facility
|
IP
|
$14,418.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.48 |
| Max. Negotiated Rate |
$13,841.52 |
| Rate for Payer: Aetna Commercial |
$11,102.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,246.24
|
| Rate for Payer: Cash Price |
$7,209.12
|
| Rate for Payer: Cigna Commercial |
$11,967.15
|
| Rate for Payer: First Health Commercial |
$13,697.34
|
| Rate for Payer: Humana Commercial |
$12,255.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,822.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,640.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,325.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,688.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,813.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,534.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,543.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,948.59
|
| Rate for Payer: PHCS Commercial |
$13,841.52
|
| Rate for Payer: United Healthcare All Payer |
$12,688.06
|
|
|
STEM REVER REVIS SZ 12*180
|
Facility
|
OP
|
$14,418.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.48 |
| Max. Negotiated Rate |
$13,841.52 |
| Rate for Payer: Aetna Commercial |
$11,102.05
|
| Rate for Payer: Anthem Medicaid |
$4,958.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,246.24
|
| Rate for Payer: Cash Price |
$7,209.12
|
| Rate for Payer: Cigna Commercial |
$11,967.15
|
| Rate for Payer: First Health Commercial |
$13,697.34
|
| Rate for Payer: Humana Commercial |
$12,255.51
|
| Rate for Payer: Humana KY Medicaid |
$4,958.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,008.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,822.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,640.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,325.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,057.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,688.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,813.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,534.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,543.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,948.59
|
| Rate for Payer: PHCS Commercial |
$13,841.52
|
| Rate for Payer: United Healthcare All Payer |
$12,688.06
|
|
|
STEM REVER REVIS SZ 6*180
|
Facility
|
OP
|
$14,418.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.48 |
| Max. Negotiated Rate |
$13,841.52 |
| Rate for Payer: Aetna Commercial |
$11,102.05
|
| Rate for Payer: Anthem Medicaid |
$4,958.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,246.24
|
| Rate for Payer: Cash Price |
$7,209.12
|
| Rate for Payer: Cigna Commercial |
$11,967.15
|
| Rate for Payer: First Health Commercial |
$13,697.34
|
| Rate for Payer: Humana Commercial |
$12,255.51
|
| Rate for Payer: Humana KY Medicaid |
$4,958.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,008.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,822.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,640.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,325.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,057.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,688.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,813.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,534.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,543.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,948.59
|
| Rate for Payer: PHCS Commercial |
$13,841.52
|
| Rate for Payer: United Healthcare All Payer |
$12,688.06
|
|
|
STEM REVER REVIS SZ 6*180
|
Facility
|
IP
|
$14,418.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.48 |
| Max. Negotiated Rate |
$13,841.52 |
| Rate for Payer: Aetna Commercial |
$11,102.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,246.24
|
| Rate for Payer: Cash Price |
$7,209.12
|
| Rate for Payer: Cigna Commercial |
$11,967.15
|
| Rate for Payer: First Health Commercial |
$13,697.34
|
| Rate for Payer: Humana Commercial |
$12,255.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,822.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,640.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,325.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,688.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,813.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,534.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,543.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,948.59
|
| Rate for Payer: PHCS Commercial |
$13,841.52
|
| Rate for Payer: United Healthcare All Payer |
$12,688.06
|
|
|
STEM REVER REVIS SZ 9*180
|
Facility
|
OP
|
$14,418.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.48 |
| Max. Negotiated Rate |
$13,841.52 |
| Rate for Payer: Aetna Commercial |
$11,102.05
|
| Rate for Payer: Anthem Medicaid |
$4,958.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,246.24
|
| Rate for Payer: Cash Price |
$7,209.12
|
| Rate for Payer: Cigna Commercial |
$11,967.15
|
| Rate for Payer: First Health Commercial |
$13,697.34
|
| Rate for Payer: Humana Commercial |
$12,255.51
|
| Rate for Payer: Humana KY Medicaid |
$4,958.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,008.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,822.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,640.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,325.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,057.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,688.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,813.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,534.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,543.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,948.59
|
| Rate for Payer: PHCS Commercial |
$13,841.52
|
| Rate for Payer: United Healthcare All Payer |
$12,688.06
|
|
|
STEM REVER REVIS SZ 9*180
|
Facility
|
IP
|
$14,418.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.48 |
| Max. Negotiated Rate |
$13,841.52 |
| Rate for Payer: Aetna Commercial |
$11,102.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,246.24
|
| Rate for Payer: Cash Price |
$7,209.12
|
| Rate for Payer: Cigna Commercial |
$11,967.15
|
| Rate for Payer: First Health Commercial |
$13,697.34
|
| Rate for Payer: Humana Commercial |
$12,255.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,822.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,640.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,325.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,688.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,813.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,534.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,543.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,948.59
|
| Rate for Payer: PHCS Commercial |
$13,841.52
|
| Rate for Payer: United Healthcare All Payer |
$12,688.06
|
|
|
STEM REVERS HUMERAL SZ 6
|
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 REVERS HUMERAL SZ 6
|
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 REVERS HUMERAL SZ 8
|
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 REVERS HUMERAL SZ 8
|
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 REVERS HUM UNIVERS
|
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 REVERS HUM UNIVERS
|
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 RHEAD LATERAL SZ 3
|
Facility
|
OP
|
$20,742.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,222.75 |
| Max. Negotiated Rate |
$19,912.80 |
| Rate for Payer: Aetna Commercial |
$15,971.73
|
| Rate for Payer: Anthem Medicaid |
$7,133.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,179.15
|
| Rate for Payer: Cash Price |
$10,371.25
|
| Rate for Payer: Cigna Commercial |
$17,216.28
|
| Rate for Payer: First Health Commercial |
$19,705.38
|
| Rate for Payer: Humana Commercial |
$17,631.12
|
| Rate for Payer: Humana KY Medicaid |
$7,133.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,205.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,008.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,307.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,222.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,276.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,253.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,556.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,045.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,312.33
|
| Rate for Payer: PHCS Commercial |
$19,912.80
|
| Rate for Payer: United Healthcare All Payer |
$18,253.40
|
|
|
STEM RHEAD LATERAL SZ 3
|
Facility
|
IP
|
$20,742.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,222.75 |
| Max. Negotiated Rate |
$19,912.80 |
| Rate for Payer: Aetna Commercial |
$15,971.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,179.15
|
| Rate for Payer: Cash Price |
$10,371.25
|
| Rate for Payer: Cigna Commercial |
$17,216.28
|
| Rate for Payer: First Health Commercial |
$19,705.38
|
| Rate for Payer: Humana Commercial |
$17,631.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,008.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,307.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,222.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,253.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,556.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,045.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,312.33
|
| Rate for Payer: PHCS Commercial |
$19,912.80
|
| Rate for Payer: United Healthcare All Payer |
$18,253.40
|
|
|
STEM SEG BOWED VSS 12MMX190MM
|
Facility
|
OP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem Medicaid |
$7,582.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Humana KY Medicaid |
$7,582.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 12MMX190MM
|
Facility
|
IP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
