|
STEM NEXGEN CEMENTED 13*105*60
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN CEMENTED 13*105*60
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN CEMENTED 13*75*30
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN CEMENTED 13*75*30
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 10X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 10X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 11X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 11X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 12X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 12X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 13X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 13X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 14X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 14X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 15X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 15X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 16X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 16X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 17X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 17X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 18X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 18X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 19X175MM
|
Facility
|
IP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 19X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
|
STEM NEXGEN FLUTD EXT 20X175MM
|
Facility
|
OP
|
$6,711.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$6,442.89 |
| Rate for Payer: Aetna Commercial |
$5,167.73
|
| Rate for Payer: Anthem Medicaid |
$2,308.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,234.85
|
| Rate for Payer: Cash Price |
$3,355.67
|
| Rate for Payer: Cigna Commercial |
$5,570.41
|
| Rate for Payer: First Health Commercial |
$6,375.77
|
| Rate for Payer: Humana Commercial |
$5,704.64
|
| Rate for Payer: Humana KY Medicaid |
$2,308.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,331.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,503.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,013.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,354.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,905.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.52
|
| Rate for Payer: PHCS Commercial |
$6,442.89
|
| Rate for Payer: United Healthcare All Payer |
$5,905.98
|
|
