|
STEM NXGN STRGHT EXT 12X200MM
|
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 12X200MM
|
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 13X145MM
|
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 13X145MM
|
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 13X200MM
|
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 13X200MM
|
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 14X145MM
|
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 14X145MM
|
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 14X200MM
|
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 14X200MM
|
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 15X145MM
|
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 15X145MM
|
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 15X200MM
|
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 15X200MM
|
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 16X145MM
|
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 16X145MM
|
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 16X200MM
|
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 16X200MM
|
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 17X145MM
|
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 17X145MM
|
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 17X200MM
|
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 17X200MM
|
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 18X145MM
|
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 18X145MM
|
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 18X200MM
|
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
|
|
