|
STEM LPS PC FEM 12.5*150MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 12.5*150MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 12.5*200MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 12.5*200MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 13.5*150MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 13.5*150MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 14.5*150MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 14.5*150MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 14.5*200MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 14.5*200MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 15.5*150MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 15.5*150MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 16.5*150MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 16.5*150MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 16.5*200MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 16.5*200MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 17.5*150MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 17.5*150MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 18.5*150MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 18.5*150MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 18.5*200MM BOW
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS PC FEM 18.5*200MM BOW
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS POROUS 10.5*100MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 10.5*100MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 11.5*100MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
