|
STEM WAGNER DIST PROV SZ 13
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 14
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 14
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 15
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 15
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 16
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 16
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 17
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 17
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 18
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 18
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 19
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 19
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 20
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 20
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 21
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 21
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 22
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 22
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 23
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 23
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 24
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STEM WAGNER DIST PROV SZ 24
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
STENT 15MM ON 5MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 15MM ON 5MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
