|
STEM LPS CEM 17*125MM STR
|
Facility
|
IP
|
$26,532.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,449.17 |
| Max. Negotiated Rate |
$25,470.82 |
| Rate for Payer: Aetna Commercial |
$20,429.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,695.04
|
| Rate for Payer: Cash Price |
$13,266.05
|
| Rate for Payer: Cigna Commercial |
$22,021.64
|
| Rate for Payer: First Health Commercial |
$25,205.50
|
| Rate for Payer: Humana Commercial |
$22,552.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,756.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,580.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,959.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,348.25
|
| Rate for Payer: Ohio Health Group HMO |
$19,899.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,306.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,449.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,224.95
|
| Rate for Payer: PHCS Commercial |
$25,470.82
|
| Rate for Payer: United Healthcare All Payer |
$23,348.25
|
|
|
STEM LPS CEM 9*100MM STR
|
Facility
|
OP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem Medicaid |
$7,823.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Humana KY Medicaid |
$7,823.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,980.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM 9*100MM STR
|
Facility
|
IP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM FEM 11*150MM BOW
|
Facility
|
OP
|
$23,067.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.74 |
| Max. Negotiated Rate |
$22,144.54 |
| Rate for Payer: Aetna Commercial |
$17,761.77
|
| Rate for Payer: Anthem Medicaid |
$7,932.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Cash Price |
$11,533.61
|
| Rate for Payer: Cigna Commercial |
$19,145.80
|
| Rate for Payer: First Health Commercial |
$21,913.87
|
| Rate for Payer: Humana Commercial |
$19,607.15
|
| Rate for Payer: Humana KY Medicaid |
$7,932.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,013.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,915.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,023.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,920.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,091.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,299.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,300.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,613.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,998.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,150.84
|
| Rate for Payer: PHCS Commercial |
$22,144.54
|
| Rate for Payer: United Healthcare All Payer |
$20,299.16
|
|
|
STEM LPS CEM FEM 11*150MM BOW
|
Facility
|
IP
|
$23,067.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.74 |
| Max. Negotiated Rate |
$22,144.54 |
| Rate for Payer: Aetna Commercial |
$17,761.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Cash Price |
$11,533.61
|
| Rate for Payer: Cigna Commercial |
$19,145.80
|
| Rate for Payer: First Health Commercial |
$21,913.87
|
| Rate for Payer: Humana Commercial |
$19,607.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,915.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,023.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,920.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,299.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,300.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,613.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,998.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,150.84
|
| Rate for Payer: PHCS Commercial |
$22,144.54
|
| Rate for Payer: United Healthcare All Payer |
$20,299.16
|
|
|
STEM LPS CEM FEM 11*200MM BOW
|
Facility
|
OP
|
$10,923.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.10 |
| Max. Negotiated Rate |
$10,486.88 |
| Rate for Payer: Aetna Commercial |
$8,411.35
|
| Rate for Payer: Anthem Medicaid |
$3,756.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,520.59
|
| Rate for Payer: Cash Price |
$5,461.91
|
| Rate for Payer: Cigna Commercial |
$9,066.78
|
| Rate for Payer: First Health Commercial |
$10,377.64
|
| Rate for Payer: Humana Commercial |
$9,285.26
|
| Rate for Payer: Humana KY Medicaid |
$3,756.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,794.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,957.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,277.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,832.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,612.97
|
| Rate for Payer: Ohio Health Group HMO |
$8,192.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,184.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,386.39
|
| Rate for Payer: PHCS Commercial |
$10,486.88
|
| Rate for Payer: United Healthcare All Payer |
$9,612.97
|
|
|
STEM LPS CEM FEM 11*200MM BOW
|
Facility
|
IP
|
$10,923.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.10 |
| Max. Negotiated Rate |
$10,486.88 |
| Rate for Payer: Aetna Commercial |
$8,411.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,520.59
|
| Rate for Payer: Cash Price |
$5,461.91
|
| Rate for Payer: Cigna Commercial |
$9,066.78
|
| Rate for Payer: First Health Commercial |
$10,377.64
|
| Rate for Payer: Humana Commercial |
$9,285.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,957.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,277.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,612.97
|
| Rate for Payer: Ohio Health Group HMO |
$8,192.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,184.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,386.39
|
| Rate for Payer: PHCS Commercial |
$10,486.88
|
| Rate for Payer: United Healthcare All Payer |
$9,612.97
|
|
|
STEM LPS CEM FEM 12*150MM BOW
|
Facility
|
OP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem Medicaid |
$9,151.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Humana KY Medicaid |
$9,151.38
|
| Rate for Payer: Kentucky WC Medicaid |
$9,244.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,334.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 12*150MM BOW
|
Facility
|
IP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 13*150MM BOW
|
Facility
|
IP
|
$35,711.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,642.54 |
| Max. Negotiated Rate |
$34,283.38 |
| Rate for Payer: Aetna Commercial |
$27,498.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,855.24
|
| Rate for Payer: Cash Price |
$17,855.92
|
| Rate for Payer: Cigna Commercial |
$29,640.84
|
| Rate for Payer: First Health Commercial |
$33,926.26
|
| Rate for Payer: Humana Commercial |
$30,355.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,283.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,355.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,713.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,426.43
|
| Rate for Payer: Ohio Health Group HMO |
$26,783.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,142.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,642.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,070.67
|
| Rate for Payer: PHCS Commercial |
$34,283.38
|
| Rate for Payer: United Healthcare All Payer |
$31,426.43
|
|
|
STEM LPS CEM FEM 13*150MM BOW
|
Facility
|
OP
|
$35,711.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,642.54 |
| Max. Negotiated Rate |
$34,283.38 |
| Rate for Payer: Aetna Commercial |
$27,498.12
|
| Rate for Payer: Anthem Medicaid |
$12,281.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,855.24
|
| Rate for Payer: Cash Price |
$17,855.92
|
| Rate for Payer: Cigna Commercial |
$29,640.84
|
| Rate for Payer: First Health Commercial |
$33,926.26
|
| Rate for Payer: Humana Commercial |
$30,355.07
|
| Rate for Payer: Humana KY Medicaid |
$12,281.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,283.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,355.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,713.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,527.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,426.43
|
| Rate for Payer: Ohio Health Group HMO |
$26,783.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,142.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,642.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,070.67
|
| Rate for Payer: PHCS Commercial |
$34,283.38
|
| Rate for Payer: United Healthcare All Payer |
$31,426.43
|
|
|
STEM LPS CEM FEM 13*200MM BOW
|
Facility
|
OP
|
$23,067.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.74 |
| Max. Negotiated Rate |
$22,144.54 |
| Rate for Payer: Aetna Commercial |
$17,761.77
|
| Rate for Payer: Anthem Medicaid |
$7,932.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Cash Price |
$11,533.61
|
| Rate for Payer: Cigna Commercial |
$19,145.80
|
| Rate for Payer: First Health Commercial |
$21,913.87
|
| Rate for Payer: Humana Commercial |
$19,607.15
|
| Rate for Payer: Humana KY Medicaid |
$7,932.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,013.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,915.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,023.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,920.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,091.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,299.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,300.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,613.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,998.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,150.84
|
| Rate for Payer: PHCS Commercial |
$22,144.54
|
| Rate for Payer: United Healthcare All Payer |
$20,299.16
|
|
|
STEM LPS CEM FEM 13*200MM BOW
|
Facility
|
IP
|
$23,067.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.74 |
| Max. Negotiated Rate |
$22,144.54 |
| Rate for Payer: Aetna Commercial |
$17,761.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Cash Price |
$11,533.61
|
| Rate for Payer: Cigna Commercial |
$19,145.80
|
| Rate for Payer: First Health Commercial |
$21,913.87
|
| Rate for Payer: Humana Commercial |
$19,607.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,915.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,023.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,920.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,299.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,300.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,613.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,998.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,150.84
|
| Rate for Payer: PHCS Commercial |
$22,144.54
|
| Rate for Payer: United Healthcare All Payer |
$20,299.16
|
|
|
STEM LPS CEM FEM 14*150MM BOW
|
Facility
|
OP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem Medicaid |
$9,151.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Humana KY Medicaid |
$9,151.38
|
| Rate for Payer: Kentucky WC Medicaid |
$9,244.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,334.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 14*150MM BOW
|
Facility
|
IP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 15*150MM BOW
|
Facility
|
OP
|
$25,513.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,316.79 |
| Max. Negotiated Rate |
$24,493.20 |
| Rate for Payer: Aetna Commercial |
$19,645.59
|
| Rate for Payer: Anthem Medicaid |
$8,774.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,900.72
|
| Rate for Payer: Cash Price |
$12,756.88
|
| Rate for Payer: Cigna Commercial |
$21,176.41
|
| Rate for Payer: First Health Commercial |
$24,238.06
|
| Rate for Payer: Humana Commercial |
$21,686.69
|
| Rate for Payer: Humana KY Medicaid |
$8,774.18
|
| Rate for Payer: Kentucky WC Medicaid |
$8,863.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,921.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,829.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,654.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,950.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,452.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,135.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,102.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,316.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,909.26
|
| Rate for Payer: PHCS Commercial |
$24,493.20
|
| Rate for Payer: United Healthcare All Payer |
$22,452.10
|
|
|
STEM LPS CEM FEM 15*150MM BOW
|
Facility
|
IP
|
$25,513.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,316.79 |
| Max. Negotiated Rate |
$24,493.20 |
| Rate for Payer: Aetna Commercial |
$19,645.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,900.72
|
| Rate for Payer: Cash Price |
$12,756.88
|
| Rate for Payer: Cigna Commercial |
$21,176.41
|
| Rate for Payer: First Health Commercial |
$24,238.06
|
| Rate for Payer: Humana Commercial |
$21,686.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,921.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,829.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,654.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,452.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,135.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,102.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,316.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,909.26
|
| Rate for Payer: PHCS Commercial |
$24,493.20
|
| Rate for Payer: United Healthcare All Payer |
$22,452.10
|
|
|
STEM LPS CEM FEM 15*200MM BOW
|
Facility
|
OP
|
$29,236.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.78 |
| Max. Negotiated Rate |
$28,067.28 |
| Rate for Payer: Aetna Commercial |
$22,512.30
|
| Rate for Payer: Anthem Medicaid |
$10,054.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,804.66
|
| Rate for Payer: Cash Price |
$14,618.38
|
| Rate for Payer: Cigna Commercial |
$24,266.50
|
| Rate for Payer: First Health Commercial |
$27,774.91
|
| Rate for Payer: Humana Commercial |
$24,851.24
|
| Rate for Payer: Humana KY Medicaid |
$10,054.52
|
| Rate for Payer: Kentucky WC Medicaid |
$10,156.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,974.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,576.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,771.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,256.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,728.34
|
| Rate for Payer: Ohio Health Group HMO |
$21,927.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,847.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,800.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,063.39
|
| Rate for Payer: PHCS Commercial |
$28,067.28
|
| Rate for Payer: United Healthcare All Payer |
$25,728.34
|
|
|
STEM LPS CEM FEM 15*200MM BOW
|
Facility
|
IP
|
$29,236.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.78 |
| Max. Negotiated Rate |
$28,067.28 |
| Rate for Payer: Aetna Commercial |
$22,512.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,804.66
|
| Rate for Payer: Cash Price |
$14,618.38
|
| Rate for Payer: Cigna Commercial |
$24,266.50
|
| Rate for Payer: First Health Commercial |
$27,774.91
|
| Rate for Payer: Humana Commercial |
$24,851.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,974.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,576.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,771.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,728.34
|
| Rate for Payer: Ohio Health Group HMO |
$21,927.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,847.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,800.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,063.39
|
| Rate for Payer: PHCS Commercial |
$28,067.28
|
| Rate for Payer: United Healthcare All Payer |
$25,728.34
|
|
|
STEM LPS CEM FEM 16*150MM BOW
|
Facility
|
OP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem Medicaid |
$9,151.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Humana KY Medicaid |
$9,151.38
|
| Rate for Payer: Kentucky WC Medicaid |
$9,244.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,334.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 16*150MM BOW
|
Facility
|
IP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 17*150MM BOW
|
Facility
|
OP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem Medicaid |
$9,151.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Humana KY Medicaid |
$9,151.38
|
| Rate for Payer: Kentucky WC Medicaid |
$9,244.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,334.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 17*150MM BOW
|
Facility
|
IP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 17*200MM BOW
|
Facility
|
IP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
|
STEM LPS CEM FEM 17*200MM BOW
|
Facility
|
OP
|
$26,610.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,459.38 |
| Max. Negotiated Rate |
$25,546.16 |
| Rate for Payer: Aetna Commercial |
$20,490.15
|
| Rate for Payer: Anthem Medicaid |
$9,151.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,756.25
|
| Rate for Payer: Cash Price |
$13,305.29
|
| Rate for Payer: Cigna Commercial |
$22,086.78
|
| Rate for Payer: First Health Commercial |
$25,280.05
|
| Rate for Payer: Humana Commercial |
$22,618.99
|
| Rate for Payer: Humana KY Medicaid |
$9,151.38
|
| Rate for Payer: Kentucky WC Medicaid |
$9,244.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,820.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,638.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,983.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,334.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$19,957.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,459.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,249.28
|
| Rate for Payer: PHCS Commercial |
$25,546.16
|
| Rate for Payer: United Healthcare All Payer |
$23,417.31
|
|
