|
STEM ECHO PF FEM STD 10MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 11MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 11MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 12MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 12MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 13MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 13MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 14MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 14MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 15MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 15MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 16MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 16MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 17MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 17MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 7MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 7MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 8MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 8MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 9MM
|
Facility
|
OP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem Medicaid |
$2,695.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Humana KY Medicaid |
$2,695.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO PF FEM STD 9MM
|
Facility
|
IP
|
$7,837.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.81 |
| Max. Negotiated Rate |
$7,523.52 |
| Rate for Payer: Aetna Commercial |
$6,034.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,112.86
|
| Rate for Payer: Cash Price |
$3,918.50
|
| Rate for Payer: Cigna Commercial |
$6,504.71
|
| Rate for Payer: First Health Commercial |
$7,445.15
|
| Rate for Payer: Humana Commercial |
$6,661.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,783.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.47
|
| Rate for Payer: PHCS Commercial |
$7,523.52
|
| Rate for Payer: United Healthcare All Payer |
$6,896.56
|
|
|
STEM ECHO POR REDHIGHOFF19X175
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
STEM ECHO POR REDHIGHOFF19X175
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
STEM ECHO PORRED HI OFF 10X130
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
STEM ECHO PORRED HI OFF 10X130
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
