|
TM GLENOD 52MM * 56MM ART SURF
|
Facility
|
OP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem Medicaid |
$3,907.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Humana KY Medicaid |
$3,907.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,947.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 52MM * 56MM ART SURF
|
Facility
|
IP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 6MM DRIL W/STOP STR
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
TM GLENOD 6MM DRIL W/STOP STR
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
TM GLENOID 40MM
|
Facility
|
IP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOID 40MM
|
Facility
|
OP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem Medicaid |
$3,907.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Humana KY Medicaid |
$3,907.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,947.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOID 52MM
|
Facility
|
OP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem Medicaid |
$3,907.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Humana KY Medicaid |
$3,907.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,947.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOID 52MM
|
Facility
|
IP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOID IMPLANT SET
|
Facility
|
IP
|
$98,533.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,809.37 |
| Max. Negotiated Rate |
$94,592.26 |
| Rate for Payer: Aetna Commercial |
$75,870.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,856.21
|
| Rate for Payer: Cash Price |
$49,266.80
|
| Rate for Payer: Cigna Commercial |
$81,782.89
|
| Rate for Payer: First Health Commercial |
$93,606.92
|
| Rate for Payer: Humana Commercial |
$83,753.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,797.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,717.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,560.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,709.57
|
| Rate for Payer: Ohio Health Group HMO |
$73,900.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,706.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,809.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,545.42
|
| Rate for Payer: PHCS Commercial |
$94,592.26
|
| Rate for Payer: United Healthcare All Payer |
$86,709.57
|
|
|
TM GLENOID IMPLANT SET
|
Facility
|
OP
|
$98,533.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,809.37 |
| Max. Negotiated Rate |
$94,592.26 |
| Rate for Payer: Aetna Commercial |
$75,870.87
|
| Rate for Payer: Anthem Medicaid |
$33,885.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,856.21
|
| Rate for Payer: Cash Price |
$49,266.80
|
| Rate for Payer: Cigna Commercial |
$81,782.89
|
| Rate for Payer: First Health Commercial |
$93,606.92
|
| Rate for Payer: Humana Commercial |
$83,753.56
|
| Rate for Payer: Humana KY Medicaid |
$33,885.71
|
| Rate for Payer: Kentucky WC Medicaid |
$34,230.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,797.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,717.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,560.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,565.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,709.57
|
| Rate for Payer: Ohio Health Group HMO |
$73,900.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,706.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,809.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,545.42
|
| Rate for Payer: PHCS Commercial |
$94,592.26
|
| Rate for Payer: United Healthcare All Payer |
$86,709.57
|
|
|
TM HUM STEM 42 10*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 10*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 10*170
|
Facility
|
IP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 42 10*170
|
Facility
|
OP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem Medicaid |
$7,869.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Humana KY Medicaid |
$7,869.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,949.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,027.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 42 11*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 11*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 12*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 12*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 12*170
|
Facility
|
OP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem Medicaid |
$7,869.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Humana KY Medicaid |
$7,869.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,949.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,027.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 42 12*170
|
Facility
|
IP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 42 13*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 13*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 42 14*130
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TM HUM STEM 42 14*130
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TM HUM STEM 42 14*170
|
Facility
|
IP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
