|
STEM NXGN OFFST EXT 12MMX200MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 13MMX200MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 13MMX200MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 13MX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 13MX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 14MMX200MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 14MMX200MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 14MX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 14MX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 15MMX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 15MMX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 15MMX200MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 15MMX200MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 16MMX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 16MMX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 16MMX200MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 16MMX200MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 17MMX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 17MMX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 17MMX200MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 17MMX200MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 18MMX145MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 18MMX145MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 18MMX200MM
|
Facility
|
OP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem Medicaid |
$2,795.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Humana KY Medicaid |
$2,795.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
|
STEM NXGN OFFST EXT 18MMX200MM
|
Facility
|
IP
|
$8,130.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.93 |
| Max. Negotiated Rate |
$7,805.03 |
| Rate for Payer: Aetna Commercial |
$6,260.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,341.59
|
| Rate for Payer: Cash Price |
$4,065.12
|
| Rate for Payer: Cigna Commercial |
$6,748.10
|
| Rate for Payer: First Health Commercial |
$7,723.73
|
| Rate for Payer: Humana Commercial |
$6,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,666.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,154.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,097.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.37
|
| Rate for Payer: PHCS Commercial |
$7,805.03
|
| Rate for Payer: United Healthcare All Payer |
$7,154.61
|
|
