|
STEM NXGN STRAIGHT EXT 15X75MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRAIGHT EXT 15X75MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 10X145MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 10X145MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 11X145MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 11X145MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 12.7X75MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 12.7X75MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 12X145MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 12X145MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 12X200MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 12X200MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 13X145MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 13X145MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 13X200MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 13X200MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 14X145MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 14X145MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 14X200MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 14X200MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 15X145MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 15X145MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 15X200MM
|
Facility
|
OP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem Medicaid |
$2,368.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Humana KY Medicaid |
$2,368.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 15X200MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
|
STEM NXGN STRGHT EXT 16X145MM
|
Facility
|
IP
|
$6,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.19 |
| Max. Negotiated Rate |
$6,610.66 |
| Rate for Payer: Aetna Commercial |
$5,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,371.16
|
| Rate for Payer: Cash Price |
$3,443.05
|
| Rate for Payer: Cigna Commercial |
$5,715.46
|
| Rate for Payer: First Health Commercial |
$6,541.80
|
| Rate for Payer: Humana Commercial |
$5,853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,646.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,081.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,059.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,164.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.69
|
| Rate for Payer: PHCS Commercial |
$6,610.66
|
| Rate for Payer: United Healthcare All Payer |
$6,059.77
|
|
