|
STEM SPLINED V2 BMT 24X80
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM S-ROM 18*13*160 NK 36+8L
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM 18*13*160 NK 36+8L
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM 20*15*165 NK 36+8L
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM 20*15*165 NK 36+8L
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM 22*17*165 NK 36+8L
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM 22*17*165 NK 36+8L
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 12*06*115 30 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 12*06*115 30 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 12*07*115 30 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 12*07*115 30 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 14*08*130 30 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 14*08*130 30 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 14*09*130 30 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 14*09*130 30 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 14*09*130 36 NK
|
Facility
|
IP
|
$16,476.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,943.04 |
| Max. Negotiated Rate |
$15,817.73 |
| Rate for Payer: Aetna Commercial |
$12,687.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,851.90
|
| Rate for Payer: Cash Price |
$8,238.40
|
| Rate for Payer: Cigna Commercial |
$13,675.74
|
| Rate for Payer: First Health Commercial |
$15,652.96
|
| Rate for Payer: Humana Commercial |
$14,005.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,510.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,159.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,943.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,499.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,357.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,181.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,334.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,368.99
|
| Rate for Payer: PHCS Commercial |
$15,817.73
|
| Rate for Payer: United Healthcare All Payer |
$14,499.58
|
|
|
STEM S-ROM STD 14*09*130 36 NK
|
Facility
|
OP
|
$16,476.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,943.04 |
| Max. Negotiated Rate |
$15,817.73 |
| Rate for Payer: Aetna Commercial |
$12,687.14
|
| Rate for Payer: Anthem Medicaid |
$5,666.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,851.90
|
| Rate for Payer: Cash Price |
$8,238.40
|
| Rate for Payer: Cigna Commercial |
$13,675.74
|
| Rate for Payer: First Health Commercial |
$15,652.96
|
| Rate for Payer: Humana Commercial |
$14,005.28
|
| Rate for Payer: Humana KY Medicaid |
$5,666.37
|
| Rate for Payer: Kentucky WC Medicaid |
$5,724.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,510.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,159.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,943.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,780.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,499.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,357.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,181.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,334.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,368.99
|
| Rate for Payer: PHCS Commercial |
$15,817.73
|
| Rate for Payer: United Healthcare All Payer |
$14,499.58
|
|
|
STEM S-ROM STD 14*09*150 30 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 14*09*150 30 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 16*11*150 30 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 16*11*150 30 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 16*11*150 36 NK
|
Facility
|
IP
|
$16,476.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,943.04 |
| Max. Negotiated Rate |
$15,817.73 |
| Rate for Payer: Aetna Commercial |
$12,687.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,851.90
|
| Rate for Payer: Cash Price |
$8,238.40
|
| Rate for Payer: Cigna Commercial |
$13,675.74
|
| Rate for Payer: First Health Commercial |
$15,652.96
|
| Rate for Payer: Humana Commercial |
$14,005.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,510.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,159.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,943.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,499.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,357.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,181.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,334.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,368.99
|
| Rate for Payer: PHCS Commercial |
$15,817.73
|
| Rate for Payer: United Healthcare All Payer |
$14,499.58
|
|
|
STEM S-ROM STD 16*11*150 36 NK
|
Facility
|
OP
|
$16,476.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,943.04 |
| Max. Negotiated Rate |
$15,817.73 |
| Rate for Payer: Aetna Commercial |
$12,687.14
|
| Rate for Payer: Anthem Medicaid |
$5,666.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,851.90
|
| Rate for Payer: Cash Price |
$8,238.40
|
| Rate for Payer: Cigna Commercial |
$13,675.74
|
| Rate for Payer: First Health Commercial |
$15,652.96
|
| Rate for Payer: Humana Commercial |
$14,005.28
|
| Rate for Payer: Humana KY Medicaid |
$5,666.37
|
| Rate for Payer: Kentucky WC Medicaid |
$5,724.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,510.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,159.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,943.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,780.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,499.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,357.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,181.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,334.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,368.99
|
| Rate for Payer: PHCS Commercial |
$15,817.73
|
| Rate for Payer: United Healthcare All Payer |
$14,499.58
|
|
|
STEM S-ROM STD 18*13*160 30 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 18*13*160 30 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
