|
STEM NEXGEN FLUTD EXT 13X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 13X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 14X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 14X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 15X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 15X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 16X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 16X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 17X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 17X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 18X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 18X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 19X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 19X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 20X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 20X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 22X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 22X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 24X175MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEXGEN FLUTD EXT 24X175MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEX SHRPFLUTDEXT 10X120MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEX SHRPFLUTDEXT 10X120MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEX SHRPFLUTDEXT 11X120MM
|
Facility
|
OP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem Medicaid |
$2,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Humana KY Medicaid |
$2,376.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,401.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEX SHRPFLUTDEXT 11X120MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
|
STEM NEX SHRPFLUTDEXT 12X120MM
|
Facility
|
IP
|
$6,911.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.40 |
| Max. Negotiated Rate |
$6,634.89 |
| Rate for Payer: Aetna Commercial |
$5,321.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.85
|
| Rate for Payer: Cash Price |
$3,455.67
|
| Rate for Payer: Cigna Commercial |
$5,736.41
|
| Rate for Payer: First Health Commercial |
$6,565.77
|
| Rate for Payer: Humana Commercial |
$5,874.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,667.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,529.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,012.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,768.82
|
| Rate for Payer: PHCS Commercial |
$6,634.89
|
| Rate for Payer: United Healthcare All Payer |
$6,081.98
|
|
