|
SECURFIT HASTEM #11 132^40*170
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECURFIT HA STEM #7 132^30*130
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECURFIT HA STEM #7 132^30*130
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECURFIT HA STEM #8 132^30*140
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECURFIT HA STEM #8 132^30*140
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECURFIT HA STEM #9 132^35*150
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECURFIT HA STEM #9 132^35*150
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECUR-FIT STEM #10 14MM*35MM
|
Facility
|
IP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #10 14MM*35MM
|
Facility
|
OP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem Medicaid |
$8,017.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Humana KY Medicaid |
$8,017.00
|
| Rate for Payer: Kentucky WC Medicaid |
$8,098.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,177.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #10 16MM*35MM
|
Facility
|
IP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #10 16MM*35MM
|
Facility
|
OP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem Medicaid |
$8,017.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Humana KY Medicaid |
$8,017.00
|
| Rate for Payer: Kentucky WC Medicaid |
$8,098.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,177.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #10 35MM*160MM
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECUR-FIT STEM #10 35MM*160MM
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
SECUR-FIT STEM #11 15MM*40MM
|
Facility
|
IP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #11 15MM*40MM
|
Facility
|
OP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem Medicaid |
$8,017.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Humana KY Medicaid |
$8,017.00
|
| Rate for Payer: Kentucky WC Medicaid |
$8,098.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,177.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #11 17MM*40MM
|
Facility
|
IP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #11 17MM*40MM
|
Facility
|
OP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem Medicaid |
$8,017.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Humana KY Medicaid |
$8,017.00
|
| Rate for Payer: Kentucky WC Medicaid |
$8,098.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,177.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #12 16MM*40MM
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
SECUR-FIT STEM #12 16MM*40MM
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
SECUR-FIT STEM #12 8MM*40MM
|
Facility
|
IP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #12 8MM*40MM
|
Facility
|
OP
|
$23,312.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,993.60 |
| Max. Negotiated Rate |
$22,379.52 |
| Rate for Payer: Aetna Commercial |
$17,950.24
|
| Rate for Payer: Anthem Medicaid |
$8,017.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,183.36
|
| Rate for Payer: Cash Price |
$11,656.00
|
| Rate for Payer: Cigna Commercial |
$19,348.96
|
| Rate for Payer: First Health Commercial |
$22,146.40
|
| Rate for Payer: Humana Commercial |
$19,815.20
|
| Rate for Payer: Humana KY Medicaid |
$8,017.00
|
| Rate for Payer: Kentucky WC Medicaid |
$8,098.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,115.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,204.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,993.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,177.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,514.56
|
| Rate for Payer: Ohio Health Group HMO |
$17,484.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,281.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,085.28
|
| Rate for Payer: PHCS Commercial |
$22,379.52
|
| Rate for Payer: United Healthcare All Payer |
$20,514.56
|
|
|
SECUR-FIT STEM #13 17MM*40MM
|
Facility
|
IP
|
$18,753.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,625.91 |
| Max. Negotiated Rate |
$18,002.92 |
| Rate for Payer: Aetna Commercial |
$14,439.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,627.37
|
| Rate for Payer: Cash Price |
$9,376.52
|
| Rate for Payer: Cigna Commercial |
$15,565.02
|
| Rate for Payer: First Health Commercial |
$17,815.39
|
| Rate for Payer: Humana Commercial |
$15,940.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,377.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,839.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,625.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,502.68
|
| Rate for Payer: Ohio Health Group HMO |
$14,064.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,002.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,315.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,939.60
|
| Rate for Payer: PHCS Commercial |
$18,002.92
|
| Rate for Payer: United Healthcare All Payer |
$16,502.68
|
|
|
SECUR-FIT STEM #13 17MM*40MM
|
Facility
|
OP
|
$18,753.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,625.91 |
| Max. Negotiated Rate |
$18,002.92 |
| Rate for Payer: Aetna Commercial |
$14,439.84
|
| Rate for Payer: Anthem Medicaid |
$6,449.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,627.37
|
| Rate for Payer: Cash Price |
$9,376.52
|
| Rate for Payer: Cigna Commercial |
$15,565.02
|
| Rate for Payer: First Health Commercial |
$17,815.39
|
| Rate for Payer: Humana Commercial |
$15,940.08
|
| Rate for Payer: Humana KY Medicaid |
$6,449.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,514.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,377.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,839.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,625.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,578.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,502.68
|
| Rate for Payer: Ohio Health Group HMO |
$14,064.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,002.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,315.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,939.60
|
| Rate for Payer: PHCS Commercial |
$18,002.92
|
| Rate for Payer: United Healthcare All Payer |
$16,502.68
|
|
|
SECUR-FIT STEM #13 19MM*40MM
|
Facility
|
IP
|
$24,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,264.50 |
| Max. Negotiated Rate |
$23,246.40 |
| Rate for Payer: Aetna Commercial |
$18,645.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,887.70
|
| Rate for Payer: Cash Price |
$12,107.50
|
| Rate for Payer: Cigna Commercial |
$20,098.45
|
| Rate for Payer: First Health Commercial |
$23,004.25
|
| Rate for Payer: Humana Commercial |
$20,582.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,856.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,870.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,264.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,309.20
|
| Rate for Payer: Ohio Health Group HMO |
$18,161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,067.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,708.35
|
| Rate for Payer: PHCS Commercial |
$23,246.40
|
| Rate for Payer: United Healthcare All Payer |
$21,309.20
|
|
|
SECUR-FIT STEM #13 19MM*40MM
|
Facility
|
OP
|
$24,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,264.50 |
| Max. Negotiated Rate |
$23,246.40 |
| Rate for Payer: Aetna Commercial |
$18,645.55
|
| Rate for Payer: Anthem Medicaid |
$8,327.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,887.70
|
| Rate for Payer: Cash Price |
$12,107.50
|
| Rate for Payer: Cigna Commercial |
$20,098.45
|
| Rate for Payer: First Health Commercial |
$23,004.25
|
| Rate for Payer: Humana Commercial |
$20,582.75
|
| Rate for Payer: Humana KY Medicaid |
$8,327.54
|
| Rate for Payer: Kentucky WC Medicaid |
$8,412.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,856.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,870.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,264.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,494.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,309.20
|
| Rate for Payer: Ohio Health Group HMO |
$18,161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,067.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,708.35
|
| Rate for Payer: PHCS Commercial |
$23,246.40
|
| Rate for Payer: United Healthcare All Payer |
$21,309.20
|
|
