|
STEM UNIVERS REVERS SZ 8
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM WAGNER CONE 125^ 13MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 13MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 14MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 14MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 15MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 15MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 16MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 16MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 17MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 17MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 18MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 18MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 19MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 19MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 20MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 20MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 21MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 21MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 22MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 22MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 23MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 23MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 24MM
|
Facility
|
OP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem Medicaid |
$5,660.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Humana KY Medicaid |
$5,660.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
|
STEM WAGNER CONE 125^ 24MM
|
Facility
|
IP
|
$16,459.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.76 |
| Max. Negotiated Rate |
$15,801.30 |
| Rate for Payer: Aetna Commercial |
$12,673.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.56
|
| Rate for Payer: Cash Price |
$8,229.85
|
| Rate for Payer: Cigna Commercial |
$13,661.54
|
| Rate for Payer: First Health Commercial |
$15,636.71
|
| Rate for Payer: Humana Commercial |
$13,990.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,496.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,937.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,344.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.50
|
| Rate for Payer: PHCS Commercial |
$15,801.30
|
| Rate for Payer: United Healthcare All Payer |
$14,484.53
|
|
