|
STEM LEGION PF SP 11MMX160MM
|
Facility
|
IP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 11MMX160MM
|
Facility
|
OP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem Medicaid |
$3,467.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Humana KY Medicaid |
$3,467.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,537.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 12MMX160MM
|
Facility
|
OP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem Medicaid |
$3,467.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Humana KY Medicaid |
$3,467.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,537.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 12MMX160MM
|
Facility
|
IP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 13MMX160MM
|
Facility
|
OP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem Medicaid |
$3,467.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Humana KY Medicaid |
$3,467.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,537.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 13MMX160MM
|
Facility
|
IP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 14MMX160MM
|
Facility
|
OP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem Medicaid |
$3,467.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Humana KY Medicaid |
$3,467.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,537.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 14MMX160MM
|
Facility
|
IP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 15MMX160MM
|
Facility
|
OP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem Medicaid |
$3,467.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Humana KY Medicaid |
$3,467.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,537.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 15MMX160MM
|
Facility
|
IP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 16MMX160MM
|
Facility
|
IP
|
$11,698.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.82 |
| Max. Negotiated Rate |
$11,230.70 |
| Rate for Payer: Aetna Commercial |
$9,007.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,124.95
|
| Rate for Payer: Cash Price |
$5,849.32
|
| Rate for Payer: Cigna Commercial |
$9,709.88
|
| Rate for Payer: First Health Commercial |
$11,113.72
|
| Rate for Payer: Humana Commercial |
$9,943.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,592.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,633.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,509.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,294.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,773.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,626.58
|
| Rate for Payer: PHCS Commercial |
$11,230.70
|
| Rate for Payer: United Healthcare All Payer |
$10,294.81
|
|
|
STEM LEGION PF SP 16MMX160MM
|
Facility
|
OP
|
$11,698.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.82 |
| Max. Negotiated Rate |
$11,230.70 |
| Rate for Payer: Aetna Commercial |
$9,007.96
|
| Rate for Payer: Anthem Medicaid |
$4,023.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,124.95
|
| Rate for Payer: Cash Price |
$5,849.32
|
| Rate for Payer: Cigna Commercial |
$9,709.88
|
| Rate for Payer: First Health Commercial |
$11,113.72
|
| Rate for Payer: Humana Commercial |
$9,943.85
|
| Rate for Payer: Humana KY Medicaid |
$4,023.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,064.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,592.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,633.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,509.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,103.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,294.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,773.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,626.58
|
| Rate for Payer: PHCS Commercial |
$11,230.70
|
| Rate for Payer: United Healthcare All Payer |
$10,294.81
|
|
|
STEM LEGION PF SP 18MMX160MM
|
Facility
|
OP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem Medicaid |
$3,467.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Humana KY Medicaid |
$3,467.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,537.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LEGION PF SP 18MMX160MM
|
Facility
|
IP
|
$10,083.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.87 |
| Max. Negotiated Rate |
$9,680.24 |
| Rate for Payer: Aetna Commercial |
$7,764.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,865.19
|
| Rate for Payer: Cash Price |
$5,041.79
|
| Rate for Payer: Cigna Commercial |
$8,369.37
|
| Rate for Payer: First Health Commercial |
$9,579.40
|
| Rate for Payer: Humana Commercial |
$8,571.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,268.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,441.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,025.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,873.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,562.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.91
|
| Rate for Payer: PHCS Commercial |
$9,680.24
|
| Rate for Payer: United Healthcare All Payer |
$8,873.55
|
|
|
STEM LGN PF SP BOWED 10X220MM
|
Facility
|
OP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem Medicaid |
$4,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Humana KY Medicaid |
$4,427.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 10X220MM
|
Facility
|
IP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 11X220MM
|
Facility
|
OP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem Medicaid |
$4,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Humana KY Medicaid |
$4,427.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 11X220MM
|
Facility
|
IP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 12X220MM
|
Facility
|
OP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem Medicaid |
$4,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Humana KY Medicaid |
$4,427.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 12X220MM
|
Facility
|
IP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 13X220MM
|
Facility
|
IP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 13X220MM
|
Facility
|
OP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem Medicaid |
$4,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Humana KY Medicaid |
$4,427.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 14X220MM
|
Facility
|
OP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem Medicaid |
$4,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Humana KY Medicaid |
$4,427.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 14X220MM
|
Facility
|
IP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM LGN PF SP BOWED 15X220MM
|
Facility
|
OP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem Medicaid |
$4,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Humana KY Medicaid |
$4,427.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
