|
STEM WAGNER CONE 125^ 17MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 18MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 18MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 19MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 19MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 20MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 20MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 21MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 21MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 22MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 22MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 23MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 23MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 24MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 24MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 13MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 13MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 14MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 14MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 15MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 15MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 16MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 16MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 17MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 17MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
