|
STEM STRGHT COLLARED OSS 9X150
|
Facility
|
IP
|
$13,673.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,101.97 |
| Max. Negotiated Rate |
$13,126.31 |
| Rate for Payer: Aetna Commercial |
$10,528.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,665.13
|
| Rate for Payer: Cash Price |
$6,836.62
|
| Rate for Payer: Cigna Commercial |
$11,348.79
|
| Rate for Payer: First Health Commercial |
$12,989.58
|
| Rate for Payer: Humana Commercial |
$11,622.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,212.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,090.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,101.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,032.45
|
| Rate for Payer: Ohio Health Group HMO |
$10,254.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,938.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,895.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,434.54
|
| Rate for Payer: PHCS Commercial |
$13,126.31
|
| Rate for Payer: United Healthcare All Payer |
$12,032.45
|
|
|
STEM STRGHT COLLARED OSS 9X150
|
Facility
|
OP
|
$13,673.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,101.97 |
| Max. Negotiated Rate |
$13,126.31 |
| Rate for Payer: Aetna Commercial |
$10,528.39
|
| Rate for Payer: Anthem Medicaid |
$4,702.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,665.13
|
| Rate for Payer: Cash Price |
$6,836.62
|
| Rate for Payer: Cigna Commercial |
$11,348.79
|
| Rate for Payer: First Health Commercial |
$12,989.58
|
| Rate for Payer: Humana Commercial |
$11,622.25
|
| Rate for Payer: Humana KY Medicaid |
$4,702.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4,750.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,212.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,090.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,101.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,796.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,032.45
|
| Rate for Payer: Ohio Health Group HMO |
$10,254.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,938.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,895.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,434.54
|
| Rate for Payer: PHCS Commercial |
$13,126.31
|
| Rate for Payer: United Healthcare All Payer |
$12,032.45
|
|
|
STEM STRT GRIT BLST PS 10X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 10X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 11X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 11X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 12X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 12X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 13X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 13X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 14X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 14X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 15X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 15X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 16X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 16X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 18X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 18X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 20X220
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM STRT GRIT BLST PS 20X220
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM TAPERLOC COMP XR 10.0
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM TAPERLOC COMP XR 10.0
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM TAPERLOC COMP XR 11.0
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM TAPERLOC COMP XR 11.0
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM TAPERLOC COMP XR 12.0
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
