|
TM GLENOID IMPLANT SET
|
Facility
|
IP
|
$102,368.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30,710.64 |
| Max. Negotiated Rate |
$98,274.05 |
| Rate for Payer: Aetna Commercial |
$78,823.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,847.66
|
| Rate for Payer: Cash Price |
$51,184.40
|
| Rate for Payer: Cigna Commercial |
$84,966.10
|
| Rate for Payer: First Health Commercial |
$97,250.36
|
| Rate for Payer: Humana Commercial |
$87,013.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,942.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,548.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,710.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$90,084.54
|
| Rate for Payer: Ohio Health Group HMO |
$76,776.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,895.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89,060.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,634.47
|
| Rate for Payer: PHCS Commercial |
$98,274.05
|
| Rate for Payer: United Healthcare All Payer |
$90,084.54
|
|
|
TM HUM STEM 42 10*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 10*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 10*170
|
Facility
|
OP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem Medicaid |
$8,108.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Humana KY Medicaid |
$8,108.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,190.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,270.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 42 10*170
|
Facility
|
IP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 42 11*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 11*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 12*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 12*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 12*170
|
Facility
|
OP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem Medicaid |
$8,108.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Humana KY Medicaid |
$8,108.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,190.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,270.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 42 12*170
|
Facility
|
IP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 42 13*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 13*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TM HUM STEM 42 14*170
|
Facility
|
OP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem Medicaid |
$8,108.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Humana KY Medicaid |
$8,108.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,190.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,270.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 42 14*170
|
Facility
|
IP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 42 15*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 15*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 16*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 16*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 17*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 17*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 18*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 42 18*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
