|
STEM LGN PF SP BOWED 15X220MM
|
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 16X220MM
|
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 16X220MM
|
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 18X220MM
|
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 18X220MM
|
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 LNG GII 10MMX100MM
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 10MMX100MM
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 10MMX150MM
|
Facility
|
IP
|
$7,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.91 |
| Max. Negotiated Rate |
$7,664.55 |
| Rate for Payer: Aetna Commercial |
$6,147.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,227.45
|
| Rate for Payer: Cash Price |
$3,991.96
|
| Rate for Payer: Cigna Commercial |
$6,626.65
|
| Rate for Payer: First Health Commercial |
$7,584.71
|
| Rate for Payer: Humana Commercial |
$6,786.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,546.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,892.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,395.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,025.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,987.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.01
|
| Rate for Payer: PHCS Commercial |
$7,664.55
|
| Rate for Payer: United Healthcare All Payer |
$7,025.84
|
|
|
STEM LNG GII 10MMX150MM
|
Facility
|
OP
|
$7,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.91 |
| Max. Negotiated Rate |
$7,664.55 |
| Rate for Payer: Aetna Commercial |
$6,147.61
|
| Rate for Payer: Anthem Medicaid |
$2,745.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,227.45
|
| Rate for Payer: Cash Price |
$3,991.96
|
| Rate for Payer: Cigna Commercial |
$6,626.65
|
| Rate for Payer: First Health Commercial |
$7,584.71
|
| Rate for Payer: Humana Commercial |
$6,786.32
|
| Rate for Payer: Humana KY Medicaid |
$2,745.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,773.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,546.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,892.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,395.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,800.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,025.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,987.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.01
|
| Rate for Payer: PHCS Commercial |
$7,664.55
|
| Rate for Payer: United Healthcare All Payer |
$7,025.84
|
|
|
STEM LNG GII 10MMX150MM W/SLOT
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 10MMX150MM W/SLOT
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 12MMX100MM
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 12MMX100MM
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 12MMX150MM
|
Facility
|
IP
|
$7,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.91 |
| Max. Negotiated Rate |
$7,664.55 |
| Rate for Payer: Aetna Commercial |
$6,147.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,227.45
|
| Rate for Payer: Cash Price |
$3,991.96
|
| Rate for Payer: Cigna Commercial |
$6,626.65
|
| Rate for Payer: First Health Commercial |
$7,584.71
|
| Rate for Payer: Humana Commercial |
$6,786.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,546.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,892.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,395.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,025.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,987.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.01
|
| Rate for Payer: PHCS Commercial |
$7,664.55
|
| Rate for Payer: United Healthcare All Payer |
$7,025.84
|
|
|
STEM LNG GII 12MMX150MM
|
Facility
|
OP
|
$7,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.91 |
| Max. Negotiated Rate |
$7,664.55 |
| Rate for Payer: Aetna Commercial |
$6,147.61
|
| Rate for Payer: Anthem Medicaid |
$2,745.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,227.45
|
| Rate for Payer: Cash Price |
$3,991.96
|
| Rate for Payer: Cigna Commercial |
$6,626.65
|
| Rate for Payer: First Health Commercial |
$7,584.71
|
| Rate for Payer: Humana Commercial |
$6,786.32
|
| Rate for Payer: Humana KY Medicaid |
$2,745.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,773.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,546.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,892.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,395.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,800.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,025.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,987.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.01
|
| Rate for Payer: PHCS Commercial |
$7,664.55
|
| Rate for Payer: United Healthcare All Payer |
$7,025.84
|
|
|
STEM LNG GII 12MMX150MM W/SLOT
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 12MMX150MM W/SLOT
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 14MMX100MM
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 14MMX100MM
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 14MMX150MM
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 14MMX150MM
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 14MMX200MM
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 14MMX200MM
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 16MMX100MM
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 16MMX100MM
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
