|
STEM WAGNER CONE 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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 135^ 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
|
|
|
STEM WAGNER DIST PROV SZ 13
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
