|
STEM NXGN OFFST EXT 15MMX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 15MMX200MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 15MMX200MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 16MMX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 16MMX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 16MMX200MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 16MMX200MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 17MMX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 17MMX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 17MMX200MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 17MMX200MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 18MMX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 18MMX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 18MMX200MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 18MMX200MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN STRAIGHT EXT 15X75MM
|
Facility
|
OP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem Medicaid |
$2,436.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Humana KY Medicaid |
$2,436.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRAIGHT EXT 15X75MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 10X145MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 10X145MM
|
Facility
|
OP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem Medicaid |
$2,436.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Humana KY Medicaid |
$2,436.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 11X145MM
|
Facility
|
OP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem Medicaid |
$2,436.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Humana KY Medicaid |
$2,436.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 11X145MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 12.7X75MM
|
Facility
|
OP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem Medicaid |
$2,436.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Humana KY Medicaid |
$2,436.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 12.7X75MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 12X145MM
|
Facility
|
OP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem Medicaid |
$2,436.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Humana KY Medicaid |
$2,436.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
|
STEM NXGN STRGHT EXT 12X145MM
|
Facility
|
IP
|
$7,086.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.83 |
| Max. Negotiated Rate |
$6,802.66 |
| Rate for Payer: Aetna Commercial |
$5,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.16
|
| Rate for Payer: Cash Price |
$3,543.05
|
| Rate for Payer: Cigna Commercial |
$5,881.46
|
| Rate for Payer: First Health Commercial |
$6,731.80
|
| Rate for Payer: Humana Commercial |
$6,023.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,235.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,668.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,164.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,889.41
|
| Rate for Payer: PHCS Commercial |
$6,802.66
|
| Rate for Payer: United Healthcare All Payer |
$6,235.77
|
|
