|
STEM NEX SHRPFLUTDEXT 20X120MM
|
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 NEX SHRPFLUTDEXT 20X120MM
|
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 NEX SHRPFLUTDEXT 22X120MM
|
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 NEX SHRPFLUTDEXT 22X120MM
|
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 NEX SHRPFLUTDEXT 24X120MM
|
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 NEX SHRPFLUTDEXT 24X120MM
|
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
|
|
|
STEMNTAL FEM/TIB M/F PROV 30MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTAL FEM/TIB M/F PROV 30MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTAL FEM/TIB M/F PROV 40MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTAL FEM/TIB M/F PROV 40MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTAL FEM/TIB M/F PROV 60MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTAL FEM/TIB M/F PROV 60MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTAL FEM/TIB M/F PROV 80MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTAL FEM/TIB M/F PROV 80MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTL FEM/TIB M/F PROV 100MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTL FEM/TIB M/F PROV 100MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTL FEM/TIB M/F PROV 120MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTL FEM/TIB M/F PROV 120MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTL FEM/TIB M/F PROV 140MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEMNTL FEM/TIB M/F PROV 140MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
STEM NXGN OFFST EXT 11MMX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 11MMX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 12MMX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 12MMX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 12MMX200MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
