|
SECUR-FIT STEM #10 16MM*35MM
|
Facility
|
OP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem Medicaid |
$7,780.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Humana KY Medicaid |
$7,780.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #10 35MM*160MM
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECUR-FIT STEM #10 35MM*160MM
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECUR-FIT STEM #11 15MM*40MM
|
Facility
|
OP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem Medicaid |
$7,780.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Humana KY Medicaid |
$7,780.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #11 15MM*40MM
|
Facility
|
IP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #11 17MM*40MM
|
Facility
|
OP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem Medicaid |
$7,780.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Humana KY Medicaid |
$7,780.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #11 17MM*40MM
|
Facility
|
IP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #12 16MM*40MM
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
SECUR-FIT STEM #12 16MM*40MM
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
SECUR-FIT STEM #12 8MM*40MM
|
Facility
|
IP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #12 8MM*40MM
|
Facility
|
OP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem Medicaid |
$7,780.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Humana KY Medicaid |
$7,780.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #13 17MM*40MM
|
Facility
|
OP
|
$18,165.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.47 |
| Max. Negotiated Rate |
$17,438.52 |
| Rate for Payer: Aetna Commercial |
$13,987.14
|
| Rate for Payer: Anthem Medicaid |
$6,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,168.79
|
| Rate for Payer: Cash Price |
$9,082.56
|
| Rate for Payer: Cigna Commercial |
$15,077.05
|
| Rate for Payer: First Health Commercial |
$17,256.86
|
| Rate for Payer: Humana Commercial |
$15,440.35
|
| Rate for Payer: Humana KY Medicaid |
$6,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,310.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,895.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,405.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,449.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,372.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,985.31
|
| Rate for Payer: Ohio Health Group HMO |
$13,623.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,631.19
|
| Rate for Payer: PHCS Commercial |
$17,438.52
|
| Rate for Payer: United Healthcare All Payer |
$15,985.31
|
|
|
SECUR-FIT STEM #13 17MM*40MM
|
Facility
|
IP
|
$18,165.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.47 |
| Max. Negotiated Rate |
$17,438.52 |
| Rate for Payer: Aetna Commercial |
$13,987.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,168.79
|
| Rate for Payer: Cash Price |
$9,082.56
|
| Rate for Payer: Cigna Commercial |
$15,077.05
|
| Rate for Payer: First Health Commercial |
$17,256.86
|
| Rate for Payer: Humana Commercial |
$15,440.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,895.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,405.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,449.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,985.31
|
| Rate for Payer: Ohio Health Group HMO |
$13,623.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,631.19
|
| Rate for Payer: PHCS Commercial |
$17,438.52
|
| Rate for Payer: United Healthcare All Payer |
$15,985.31
|
|
|
SECUR-FIT STEM #13 19MM*40MM
|
Facility
|
IP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #13 19MM*40MM
|
Facility
|
OP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem Medicaid |
$8,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Humana KY Medicaid |
$8,082.54
|
| Rate for Payer: Kentucky WC Medicaid |
$8,164.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,244.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #14 18MM*40MM
|
Facility
|
OP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem Medicaid |
$8,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Humana KY Medicaid |
$8,082.54
|
| Rate for Payer: Kentucky WC Medicaid |
$8,164.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,244.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #14 18MM*40MM
|
Facility
|
IP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #14 20MM*40MM
|
Facility
|
IP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #14 20MM*40MM
|
Facility
|
OP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem Medicaid |
$8,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Humana KY Medicaid |
$8,082.54
|
| Rate for Payer: Kentucky WC Medicaid |
$8,164.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,244.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #5 10MM*30MM
|
Facility
|
IP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #5 10MM*30MM
|
Facility
|
OP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem Medicaid |
$8,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Humana KY Medicaid |
$8,082.54
|
| Rate for Payer: Kentucky WC Medicaid |
$8,164.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,244.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #5 25MM*110MM
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECUR-FIT STEM #5 25MM*110MM
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECUR-FIT STEM #5 9MM*30MM
|
Facility
|
OP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem Medicaid |
$8,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Humana KY Medicaid |
$8,082.54
|
| Rate for Payer: Kentucky WC Medicaid |
$8,164.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,244.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
|
SECUR-FIT STEM #5 9MM*30MM
|
Facility
|
IP
|
$23,502.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.34 |
| Max. Negotiated Rate |
$22,562.50 |
| Rate for Payer: Aetna Commercial |
$18,097.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,332.03
|
| Rate for Payer: Cash Price |
$11,751.30
|
| Rate for Payer: Cigna Commercial |
$19,507.16
|
| Rate for Payer: First Health Commercial |
$22,327.47
|
| Rate for Payer: Humana Commercial |
$19,977.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,272.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,344.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,050.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,682.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,626.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,700.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,285.81
|
| Rate for Payer: PHCS Commercial |
$22,562.50
|
| Rate for Payer: United Healthcare All Payer |
$20,682.29
|
|
