|
STEM SEG BOWED VSS 13MMX190MM
|
Facility
|
IP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 13MMX190MM
|
Facility
|
OP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem Medicaid |
$7,582.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Humana KY Medicaid |
$7,582.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 14MMX190MM
|
Facility
|
OP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem Medicaid |
$7,582.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Humana KY Medicaid |
$7,582.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 14MMX190MM
|
Facility
|
IP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 15MMX190MM
|
Facility
|
IP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 15MMX190MM
|
Facility
|
OP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem Medicaid |
$7,582.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Humana KY Medicaid |
$7,582.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 16MMX190MM
|
Facility
|
OP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem Medicaid |
$7,582.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Humana KY Medicaid |
$7,582.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 16MMX190MM
|
Facility
|
IP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 17MMX190MM
|
Facility
|
IP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 17MMX190MM
|
Facility
|
OP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem Medicaid |
$7,582.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Humana KY Medicaid |
$7,582.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 18MMX190MM
|
Facility
|
IP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 18MMX190MM
|
Facility
|
OP
|
$22,047.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.18 |
| Max. Negotiated Rate |
$21,165.39 |
| Rate for Payer: Aetna Commercial |
$16,976.41
|
| Rate for Payer: Anthem Medicaid |
$7,582.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.88
|
| Rate for Payer: Cash Price |
$11,023.64
|
| Rate for Payer: Cigna Commercial |
$18,299.24
|
| Rate for Payer: First Health Commercial |
$20,944.92
|
| Rate for Payer: Humana Commercial |
$18,740.19
|
| Rate for Payer: Humana KY Medicaid |
$7,582.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,078.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,401.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,535.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,637.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,181.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,212.62
|
| Rate for Payer: PHCS Commercial |
$21,165.39
|
| Rate for Payer: United Healthcare All Payer |
$19,401.61
|
|
|
STEM SEG BOWED VSS 19MMX190MM
|
Facility
|
OP
|
$22,045.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,613.73 |
| Max. Negotiated Rate |
$21,163.95 |
| Rate for Payer: Aetna Commercial |
$16,975.25
|
| Rate for Payer: Anthem Medicaid |
$7,581.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,195.71
|
| Rate for Payer: Cash Price |
$11,022.89
|
| Rate for Payer: Cigna Commercial |
$18,298.00
|
| Rate for Payer: First Health Commercial |
$20,943.49
|
| Rate for Payer: Humana Commercial |
$18,738.91
|
| Rate for Payer: Humana KY Medicaid |
$7,581.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,658.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,269.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,733.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.29
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,636.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,179.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,211.59
|
| Rate for Payer: PHCS Commercial |
$21,163.95
|
| Rate for Payer: United Healthcare All Payer |
$19,400.29
|
|
|
STEM SEG BOWED VSS 19MMX190MM
|
Facility
|
IP
|
$22,045.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,613.73 |
| Max. Negotiated Rate |
$21,163.95 |
| Rate for Payer: Aetna Commercial |
$16,975.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,195.71
|
| Rate for Payer: Cash Price |
$11,022.89
|
| Rate for Payer: Cigna Commercial |
$18,298.00
|
| Rate for Payer: First Health Commercial |
$20,943.49
|
| Rate for Payer: Humana Commercial |
$18,738.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,269.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.29
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,636.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,179.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,211.59
|
| Rate for Payer: PHCS Commercial |
$21,163.95
|
| Rate for Payer: United Healthcare All Payer |
$19,400.29
|
|
|
STEM SEG STR VSS 12MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 12MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 13MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 13MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 14MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 14MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 15MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 15MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 16MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 16MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 17MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
