|
STEM LEGION PF SP 16MMX160MM
|
Facility
|
OP
|
$11,944.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,583.40 |
| Max. Negotiated Rate |
$11,466.88 |
| Rate for Payer: Aetna Commercial |
$9,197.40
|
| Rate for Payer: Anthem Medicaid |
$4,107.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,316.84
|
| Rate for Payer: Cash Price |
$5,972.34
|
| Rate for Payer: Cigna Commercial |
$9,914.08
|
| Rate for Payer: First Health Commercial |
$11,347.44
|
| Rate for Payer: Humana Commercial |
$10,152.97
|
| Rate for Payer: Humana KY Medicaid |
$4,107.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,149.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,794.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,815.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,583.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,190.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,511.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,555.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,391.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,241.82
|
| Rate for Payer: PHCS Commercial |
$11,466.88
|
| Rate for Payer: United Healthcare All Payer |
$10,511.31
|
|
|
STEM LEGION PF SP 16MMX160MM
|
Facility
|
IP
|
$11,944.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,583.40 |
| Max. Negotiated Rate |
$11,466.88 |
| Rate for Payer: Aetna Commercial |
$9,197.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,316.84
|
| Rate for Payer: Cash Price |
$5,972.34
|
| Rate for Payer: Cigna Commercial |
$9,914.08
|
| Rate for Payer: First Health Commercial |
$11,347.44
|
| Rate for Payer: Humana Commercial |
$10,152.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,794.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,815.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,583.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,511.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,555.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,391.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,241.82
|
| Rate for Payer: PHCS Commercial |
$11,466.88
|
| Rate for Payer: United Healthcare All Payer |
$10,511.31
|
|
|
STEM LEGION PF SP 18MMX160MM
|
Facility
|
OP
|
$10,283.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,085.07 |
| Max. Negotiated Rate |
$9,872.24 |
| Rate for Payer: Aetna Commercial |
$7,918.36
|
| Rate for Payer: Anthem Medicaid |
$3,536.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,021.19
|
| Rate for Payer: Cash Price |
$5,141.79
|
| Rate for Payer: Cigna Commercial |
$8,535.37
|
| Rate for Payer: First Health Commercial |
$9,769.40
|
| Rate for Payer: Humana Commercial |
$8,741.04
|
| Rate for Payer: Humana KY Medicaid |
$3,536.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3,572.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,432.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,589.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,085.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,607.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,049.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,712.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,226.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,946.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,095.67
|
| Rate for Payer: PHCS Commercial |
$9,872.24
|
| Rate for Payer: United Healthcare All Payer |
$9,049.55
|
|
|
STEM LEGION PF SP 18MMX160MM
|
Facility
|
IP
|
$10,283.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,085.07 |
| Max. Negotiated Rate |
$9,872.24 |
| Rate for Payer: Aetna Commercial |
$7,918.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,021.19
|
| Rate for Payer: Cash Price |
$5,141.79
|
| Rate for Payer: Cigna Commercial |
$8,535.37
|
| Rate for Payer: First Health Commercial |
$9,769.40
|
| Rate for Payer: Humana Commercial |
$8,741.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,432.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,589.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,085.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,049.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,712.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,226.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,946.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,095.67
|
| Rate for Payer: PHCS Commercial |
$9,872.24
|
| Rate for Payer: United Healthcare All Payer |
$9,049.55
|
|
|
STEM LGN PF SP BOWED 10X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 10X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 11X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 11X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 12X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 12X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 13X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 13X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 14X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 14X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 15X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 15X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 16X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 16X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 18X220MM
|
Facility
|
IP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LGN PF SP BOWED 18X220MM
|
Facility
|
OP
|
$13,125.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.65 |
| Max. Negotiated Rate |
$12,600.47 |
| Rate for Payer: Aetna Commercial |
$10,106.63
|
| Rate for Payer: Anthem Medicaid |
$4,513.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,237.88
|
| Rate for Payer: Cash Price |
$6,562.75
|
| Rate for Payer: Cigna Commercial |
$10,894.16
|
| Rate for Payer: First Health Commercial |
$12,469.22
|
| Rate for Payer: Humana Commercial |
$11,156.67
|
| Rate for Payer: Humana KY Medicaid |
$4,513.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,762.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,686.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,937.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,604.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,550.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,844.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,500.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,419.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,056.59
|
| Rate for Payer: PHCS Commercial |
$12,600.47
|
| Rate for Payer: United Healthcare All Payer |
$11,550.43
|
|
|
STEM LNG GII 10MMX100MM
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 10MMX100MM
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 10MMX150MM
|
Facility
|
IP
|
$8,183.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.17 |
| Max. Negotiated Rate |
$7,856.55 |
| Rate for Payer: Aetna Commercial |
$6,301.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,383.45
|
| Rate for Payer: Cash Price |
$4,091.96
|
| Rate for Payer: Cigna Commercial |
$6,792.65
|
| Rate for Payer: First Health Commercial |
$7,774.71
|
| Rate for Payer: Humana Commercial |
$6,956.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,547.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,120.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.90
|
| Rate for Payer: PHCS Commercial |
$7,856.55
|
| Rate for Payer: United Healthcare All Payer |
$7,201.84
|
|
|
STEM LNG GII 10MMX150MM
|
Facility
|
OP
|
$8,183.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.17 |
| Max. Negotiated Rate |
$7,856.55 |
| Rate for Payer: Aetna Commercial |
$6,301.61
|
| Rate for Payer: Anthem Medicaid |
$2,814.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,383.45
|
| Rate for Payer: Cash Price |
$4,091.96
|
| Rate for Payer: Cigna Commercial |
$6,792.65
|
| Rate for Payer: First Health Commercial |
$7,774.71
|
| Rate for Payer: Humana Commercial |
$6,956.32
|
| Rate for Payer: Humana KY Medicaid |
$2,814.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,843.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,547.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,120.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.90
|
| Rate for Payer: PHCS Commercial |
$7,856.55
|
| Rate for Payer: United Healthcare All Payer |
$7,201.84
|
|
|
STEM LNG GII 10MMX150MM W/SLOT
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
