|
STEM ECHO BIFL PROX STD 18*170
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BIFL PROX STD 19*175
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BIFL PROX STD 19*175
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BIFL PROX STD 20*180
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BIFL PROX STD 20*180
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BIFL PROX STD 21*185
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BIFL PROX STD 21*185
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BI FL PROX STD 7*115
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BI FL PROX STD 7*115
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BI FL PROX STD 8*120
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BI FL PROX STD 8*120
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BI FL PROX STD 9*125
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO BI FL PROX STD 9*125
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
STEM ECHO COCR FEM HO 11MM
|
Facility
|
OP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem Medicaid |
$2,763.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Humana KY Medicaid |
$2,763.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 11MM
|
Facility
|
IP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 13MM
|
Facility
|
OP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem Medicaid |
$2,763.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Humana KY Medicaid |
$2,763.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 13MM
|
Facility
|
IP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 15MM
|
Facility
|
IP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 15MM
|
Facility
|
OP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem Medicaid |
$2,763.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Humana KY Medicaid |
$2,763.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 17MM
|
Facility
|
OP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem Medicaid |
$2,763.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Humana KY Medicaid |
$2,763.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 17MM
|
Facility
|
IP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 9MM
|
Facility
|
OP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem Medicaid |
$2,763.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Humana KY Medicaid |
$2,763.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM HO 9MM
|
Facility
|
IP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM STD 11MM
|
Facility
|
OP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem Medicaid |
$2,763.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Humana KY Medicaid |
$2,763.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
|
STEM ECHO COCR FEM STD 11MM
|
Facility
|
IP
|
$8,037.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.10 |
| Max. Negotiated Rate |
$7,715.52 |
| Rate for Payer: Aetna Commercial |
$6,188.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,268.86
|
| Rate for Payer: Cash Price |
$4,018.50
|
| Rate for Payer: Cigna Commercial |
$6,670.71
|
| Rate for Payer: First Health Commercial |
$7,635.15
|
| Rate for Payer: Humana Commercial |
$6,831.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,072.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,027.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,992.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,545.53
|
| Rate for Payer: PHCS Commercial |
$7,715.52
|
| Rate for Payer: United Healthcare All Payer |
$7,072.56
|
|
