|
STEM NEX SHRPFLUTDEXT 12X120MM
|
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 13X120MM
|
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 13X120MM
|
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 14X120MM
|
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 14X120MM
|
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 15X120MM
|
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 15X120MM
|
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 16X120MM
|
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 16X120MM
|
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 17X120MM
|
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 17X120MM
|
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 18X120MM
|
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 18X120MM
|
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 19X120MM
|
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 19X120MM
|
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 20X120MM
|
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 20X120MM
|
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 22X120MM
|
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 22X120MM
|
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 24X120MM
|
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 24X120MM
|
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
|
|
|
STEMNTAL FEM/TIB M/F PROV 30MM
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTAL FEM/TIB M/F PROV 30MM
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTAL FEM/TIB M/F PROV 40MM
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTAL FEM/TIB M/F PROV 40MM
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
