|
STEM ECHO COCR FEM STD 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 STD 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 STD 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 STD 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 STD 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 STD 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 STD 7MM
|
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 7MM
|
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 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 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 MCROPLAS PROX STD 10
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 10
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 11
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 11
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 12
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 12
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 13
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 13
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 14
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 14
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 15
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 15
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 16
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 16
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM ECHO MCROPLAS PROX STD 17
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
