|
SECUR-FIT STEM #14 18MM*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 #14 18MM*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
|
|
|
SECUR-FIT STEM #14 20MM*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
|
|
|
SECUR-FIT STEM #14 20MM*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 #5 10MM*30MM
|
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 #5 10MM*30MM
|
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
|
|
|
SECUR-FIT STEM #5 25MM*110MM
|
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 #5 25MM*110MM
|
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 #5 9MM*30MM
|
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
|
|
|
SECUR-FIT STEM #5 9MM*30MM
|
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 #6 10MM*30MM
|
Facility
|
OP
|
$22,709.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,812.70 |
| Max. Negotiated Rate |
$21,800.64 |
| Rate for Payer: Aetna Commercial |
$17,485.93
|
| Rate for Payer: Anthem Medicaid |
$7,809.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,713.02
|
| Rate for Payer: Cash Price |
$11,354.50
|
| Rate for Payer: Cigna Commercial |
$18,848.47
|
| Rate for Payer: First Health Commercial |
$21,573.55
|
| Rate for Payer: Humana Commercial |
$19,302.65
|
| Rate for Payer: Humana KY Medicaid |
$7,809.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,889.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,621.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,759.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,812.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,966.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,983.92
|
| Rate for Payer: Ohio Health Group HMO |
$17,031.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,756.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,669.21
|
| Rate for Payer: PHCS Commercial |
$21,800.64
|
| Rate for Payer: United Healthcare All Payer |
$19,983.92
|
|
|
SECUR-FIT STEM #6 10MM*30MM
|
Facility
|
IP
|
$22,709.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,812.70 |
| Max. Negotiated Rate |
$21,800.64 |
| Rate for Payer: Aetna Commercial |
$17,485.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,713.02
|
| Rate for Payer: Cash Price |
$11,354.50
|
| Rate for Payer: Cigna Commercial |
$18,848.47
|
| Rate for Payer: First Health Commercial |
$21,573.55
|
| Rate for Payer: Humana Commercial |
$19,302.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,621.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,759.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,812.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,983.92
|
| Rate for Payer: Ohio Health Group HMO |
$17,031.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,756.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,669.21
|
| Rate for Payer: PHCS Commercial |
$21,800.64
|
| Rate for Payer: United Healthcare All Payer |
$19,983.92
|
|
|
SECUR-FIT STEM #6 12MM*30MM
|
Facility
|
OP
|
$24,983.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,494.90 |
| Max. Negotiated Rate |
$23,983.68 |
| Rate for Payer: Aetna Commercial |
$19,236.91
|
| Rate for Payer: Anthem Medicaid |
$8,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,486.74
|
| Rate for Payer: Cash Price |
$12,491.50
|
| Rate for Payer: Cigna Commercial |
$20,735.89
|
| Rate for Payer: First Health Commercial |
$23,733.85
|
| Rate for Payer: Humana Commercial |
$21,235.55
|
| Rate for Payer: Humana KY Medicaid |
$8,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$8,679.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,486.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,437.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,494.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,764.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,985.04
|
| Rate for Payer: Ohio Health Group HMO |
$18,737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,986.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,735.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,238.27
|
| Rate for Payer: PHCS Commercial |
$23,983.68
|
| Rate for Payer: United Healthcare All Payer |
$21,985.04
|
|
|
SECUR-FIT STEM #6 12MM*30MM
|
Facility
|
IP
|
$24,983.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,494.90 |
| Max. Negotiated Rate |
$23,983.68 |
| Rate for Payer: Aetna Commercial |
$19,236.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,486.74
|
| Rate for Payer: Cash Price |
$12,491.50
|
| Rate for Payer: Cigna Commercial |
$20,735.89
|
| Rate for Payer: First Health Commercial |
$23,733.85
|
| Rate for Payer: Humana Commercial |
$21,235.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,486.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,437.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,494.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,985.04
|
| Rate for Payer: Ohio Health Group HMO |
$18,737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,986.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,735.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,238.27
|
| Rate for Payer: PHCS Commercial |
$23,983.68
|
| Rate for Payer: United Healthcare All Payer |
$21,985.04
|
|
|
SECUR-FIT STEM #7 11MM*30MM
|
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 #7 11MM*30MM
|
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 #7 13MM*30MM
|
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 #7 13MM*30MM
|
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 #8 12MM*30MM
|
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 #8 12MM*30MM
|
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 #8 14MM*30MM
|
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 #8 14MM*30MM
|
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 #9 13MM*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 #9 13MM*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 #9 15MM*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
|
|
