|
STEM NXGN STRGHT EXT 16X145MM
|
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 16X200MM
|
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 16X200MM
|
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 17X145MM
|
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 17X145MM
|
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 17X200MM
|
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 17X200MM
|
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 18X145MM
|
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 18X145MM
|
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 18X200MM
|
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 18X200MM
|
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 20X145MM
|
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 20X145MM
|
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 22X145MM
|
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 22X145MM
|
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 24X145MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM NXGN STRGHT EXT 24X145MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM OFFSET SUPER HIGH SZ 12
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
STEM OFFSET SUPER HIGH SZ 12
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
STEM OFFSET SUPER HIGH SZ 13
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
STEM OFFSET SUPER HIGH SZ 13
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
STEM OFFSET SUPER HIGH SZ 14
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
STEM OFFSET SUPER HIGH SZ 14
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
STEM OFFSET SUPER HIGH SZ 15
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
STEM OFFSET SUPER HIGH SZ 15
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
