|
STEM PF EXT FLT 12MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 12MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 12MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 13MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 13MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 13MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 13MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 14MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 14MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 14MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 14MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 15MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 15MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 15MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 15MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 16MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 16MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 16MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 16MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 18MMX120MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 18MMX120MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 18MMX160MM
|
Facility
|
IP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM PF EXT FLT 18MMX160MM
|
Facility
|
OP
|
$9,241.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.37 |
| Max. Negotiated Rate |
$8,871.69 |
| Rate for Payer: Aetna Commercial |
$7,115.83
|
| Rate for Payer: Anthem Medicaid |
$3,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.25
|
| Rate for Payer: Cash Price |
$4,620.67
|
| Rate for Payer: Cigna Commercial |
$7,670.31
|
| Rate for Payer: First Health Commercial |
$8,779.27
|
| Rate for Payer: Humana Commercial |
$7,855.14
|
| Rate for Payer: Humana KY Medicaid |
$3,178.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,577.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,848.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.82
|
| Rate for Payer: PHCS Commercial |
$8,871.69
|
| Rate for Payer: United Healthcare All Payer |
$8,132.38
|
|
|
STEM POROUS OSS IM 10.5X90
|
Facility
|
IP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
|
STEM POROUS OSS IM 10.5X90
|
Facility
|
OP
|
$16,347.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.22 |
| Max. Negotiated Rate |
$15,693.93 |
| Rate for Payer: Aetna Commercial |
$12,587.84
|
| Rate for Payer: Anthem Medicaid |
$5,622.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,751.32
|
| Rate for Payer: Cash Price |
$8,173.92
|
| Rate for Payer: Cigna Commercial |
$13,568.71
|
| Rate for Payer: First Health Commercial |
$15,530.45
|
| Rate for Payer: Humana Commercial |
$13,895.66
|
| Rate for Payer: Humana KY Medicaid |
$5,622.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,679.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,405.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,064.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,904.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,734.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,386.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,260.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,269.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.83
|
| Rate for Payer: PHCS Commercial |
$15,693.93
|
| Rate for Payer: United Healthcare All Payer |
$14,386.10
|
|
