|
SECUR-FIT STEM #6 10MM*30MM
|
Facility
|
IP
|
$22,036.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,864.78 |
| Max. Negotiated Rate |
$21,155.29 |
| Rate for Payer: Aetna Commercial |
$16,968.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,188.67
|
| Rate for Payer: Cash Price |
$11,018.38
|
| Rate for Payer: Cigna Commercial |
$18,290.51
|
| Rate for Payer: First Health Commercial |
$20,934.92
|
| Rate for Payer: Humana Commercial |
$18,731.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,070.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,263.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,611.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,392.35
|
| Rate for Payer: Ohio Health Group HMO |
$16,527.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,407.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,831.40
|
| Rate for Payer: PHCS Commercial |
$21,155.29
|
| Rate for Payer: United Healthcare All Payer |
$19,392.35
|
|
|
SECUR-FIT STEM #6 10MM*30MM
|
Facility
|
OP
|
$22,036.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,864.78 |
| Max. Negotiated Rate |
$21,155.29 |
| Rate for Payer: Aetna Commercial |
$16,968.31
|
| Rate for Payer: Anthem Medicaid |
$7,578.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,188.67
|
| Rate for Payer: Cash Price |
$11,018.38
|
| Rate for Payer: Cigna Commercial |
$18,290.51
|
| Rate for Payer: First Health Commercial |
$20,934.92
|
| Rate for Payer: Humana Commercial |
$18,731.25
|
| Rate for Payer: Humana KY Medicaid |
$7,578.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,655.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,070.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,263.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,611.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,730.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,392.35
|
| Rate for Payer: Ohio Health Group HMO |
$16,527.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,407.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,831.40
|
| Rate for Payer: PHCS Commercial |
$21,155.29
|
| Rate for Payer: United Healthcare All Payer |
$19,392.35
|
|
|
SECUR-FIT STEM #6 12MM*30MM
|
Facility
|
OP
|
$24,250.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,152.52 |
| Max. Negotiated Rate |
$23,280.12 |
| Rate for Payer: Aetna Commercial |
$18,672.59
|
| Rate for Payer: Anthem Medicaid |
$8,339.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,915.09
|
| Rate for Payer: Cash Price |
$12,125.06
|
| Rate for Payer: Cigna Commercial |
$20,127.60
|
| Rate for Payer: First Health Commercial |
$23,037.61
|
| Rate for Payer: Humana Commercial |
$20,612.60
|
| Rate for Payer: Humana KY Medicaid |
$8,339.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,424.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,885.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,896.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,275.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,506.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,340.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,187.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,850.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,152.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,517.54
|
| Rate for Payer: PHCS Commercial |
$23,280.12
|
| Rate for Payer: United Healthcare All Payer |
$21,340.11
|
|
|
SECUR-FIT STEM #6 12MM*30MM
|
Facility
|
IP
|
$24,250.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,152.52 |
| Max. Negotiated Rate |
$23,280.12 |
| Rate for Payer: Aetna Commercial |
$18,672.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,915.09
|
| Rate for Payer: Cash Price |
$12,125.06
|
| Rate for Payer: Cigna Commercial |
$20,127.60
|
| Rate for Payer: First Health Commercial |
$23,037.61
|
| Rate for Payer: Humana Commercial |
$20,612.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,885.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,896.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,275.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,340.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,187.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,850.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,152.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,517.54
|
| Rate for Payer: PHCS Commercial |
$23,280.12
|
| Rate for Payer: United Healthcare All Payer |
$21,340.11
|
|
|
SECUR-FIT STEM #7 11MM*30MM
|
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 #7 11MM*30MM
|
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 #7 13MM*30MM
|
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 #7 13MM*30MM
|
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 #8 12MM*30MM
|
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 #8 12MM*30MM
|
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 #8 14MM*30MM
|
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 #8 14MM*30MM
|
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 #9 13MM*35MM
|
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 #9 13MM*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 #9 15MM*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 #9 15MM*35MM
|
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 #9 35MM*150MM
|
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 #9 35MM*150MM
|
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
|
|
|
SEDIMENTATION RATE AUTOMATED
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 85652
|
| Hospital Charge Code |
30000625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$4.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$2.39
|
| Rate for Payer: Healthspan PPO |
$2.83
|
| Rate for Payer: Multiplan PHCS |
$45.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.20
|
| Rate for Payer: UHCCP Medicaid |
$26.60
|
|
|
SEDIMENTATION RATE AUTOMATED
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 85652
|
| Hospital Charge Code |
30000625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
SEDIMENTATION RATE AUTOMATED
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 85652
|
| Hospital Charge Code |
30000625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.70
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Humana Medicare Advantage |
$2.70
|
| Rate for Payer: Kentucky WC Medicaid |
$26.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
SEGMENTAL BWD FLTD STEM 12*250
|
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
|
|
|
SEGMENTAL BWD FLTD STEM 12*250
|
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
|
|
|
SEGMENTAL BWD FLTD STEM 13*250
|
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
|
|
|
SEGMENTAL BWD FLTD STEM 13*250
|
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
|
|
