|
STEM LNG GII 10MMX150MM W/SLOT
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 12MMX100MM
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 12MMX100MM
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 12MMX150MM
|
Facility
|
IP
|
$8,183.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.17 |
| Max. Negotiated Rate |
$7,856.55 |
| Rate for Payer: Aetna Commercial |
$6,301.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,383.45
|
| Rate for Payer: Cash Price |
$4,091.96
|
| Rate for Payer: Cigna Commercial |
$6,792.65
|
| Rate for Payer: First Health Commercial |
$7,774.71
|
| Rate for Payer: Humana Commercial |
$6,956.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,547.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,120.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.90
|
| Rate for Payer: PHCS Commercial |
$7,856.55
|
| Rate for Payer: United Healthcare All Payer |
$7,201.84
|
|
|
STEM LNG GII 12MMX150MM
|
Facility
|
OP
|
$8,183.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.17 |
| Max. Negotiated Rate |
$7,856.55 |
| Rate for Payer: Aetna Commercial |
$6,301.61
|
| Rate for Payer: Anthem Medicaid |
$2,814.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,383.45
|
| Rate for Payer: Cash Price |
$4,091.96
|
| Rate for Payer: Cigna Commercial |
$6,792.65
|
| Rate for Payer: First Health Commercial |
$7,774.71
|
| Rate for Payer: Humana Commercial |
$6,956.32
|
| Rate for Payer: Humana KY Medicaid |
$2,814.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,843.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,547.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,120.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.90
|
| Rate for Payer: PHCS Commercial |
$7,856.55
|
| Rate for Payer: United Healthcare All Payer |
$7,201.84
|
|
|
STEM LNG GII 12MMX150MM W/SLOT
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 12MMX150MM W/SLOT
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 14MMX100MM
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 14MMX100MM
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 14MMX150MM
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 14MMX150MM
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 14MMX200MM
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 14MMX200MM
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 16MMX100MM
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 16MMX100MM
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 16MMX150MM
|
Facility
|
IP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 16MMX150MM
|
Facility
|
OP
|
$8,812.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.79 |
| Max. Negotiated Rate |
$8,460.12 |
| Rate for Payer: Aetna Commercial |
$6,785.72
|
| Rate for Payer: Anthem Medicaid |
$3,030.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.84
|
| Rate for Payer: Cash Price |
$4,406.31
|
| Rate for Payer: Cigna Commercial |
$7,314.47
|
| Rate for Payer: First Health Commercial |
$8,371.99
|
| Rate for Payer: Humana Commercial |
$7,490.73
|
| Rate for Payer: Humana KY Medicaid |
$3,030.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.71
|
| Rate for Payer: PHCS Commercial |
$8,460.12
|
| Rate for Payer: United Healthcare All Payer |
$7,755.11
|
|
|
STEM LNG GII 18MMX100MM
|
Facility
|
IP
|
$8,811.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.46 |
| Max. Negotiated Rate |
$8,459.07 |
| Rate for Payer: Aetna Commercial |
$6,784.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.99
|
| Rate for Payer: Cash Price |
$4,405.76
|
| Rate for Payer: Cigna Commercial |
$7,313.57
|
| Rate for Payer: First Health Commercial |
$8,370.95
|
| Rate for Payer: Humana Commercial |
$7,489.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,754.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,049.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.96
|
| Rate for Payer: PHCS Commercial |
$8,459.07
|
| Rate for Payer: United Healthcare All Payer |
$7,754.15
|
|
|
STEM LNG GII 18MMX100MM
|
Facility
|
OP
|
$8,811.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.46 |
| Max. Negotiated Rate |
$8,459.07 |
| Rate for Payer: Aetna Commercial |
$6,784.88
|
| Rate for Payer: Anthem Medicaid |
$3,030.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.99
|
| Rate for Payer: Cash Price |
$4,405.76
|
| Rate for Payer: Cigna Commercial |
$7,313.57
|
| Rate for Payer: First Health Commercial |
$8,370.95
|
| Rate for Payer: Humana Commercial |
$7,489.80
|
| Rate for Payer: Humana KY Medicaid |
$3,030.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,754.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,049.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.96
|
| Rate for Payer: PHCS Commercial |
$8,459.07
|
| Rate for Payer: United Healthcare All Payer |
$7,754.15
|
|
|
STEM LNG GII 22MMX100MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM LNG GII 22MMX100MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM LNG GII 24MMX100MM
|
Facility
|
OP
|
$8,811.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.46 |
| Max. Negotiated Rate |
$8,459.07 |
| Rate for Payer: Aetna Commercial |
$6,784.88
|
| Rate for Payer: Anthem Medicaid |
$3,030.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.99
|
| Rate for Payer: Cash Price |
$4,405.76
|
| Rate for Payer: Cigna Commercial |
$7,313.57
|
| Rate for Payer: First Health Commercial |
$8,370.95
|
| Rate for Payer: Humana Commercial |
$7,489.80
|
| Rate for Payer: Humana KY Medicaid |
$3,030.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,754.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,049.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.96
|
| Rate for Payer: PHCS Commercial |
$8,459.07
|
| Rate for Payer: United Healthcare All Payer |
$7,754.15
|
|
|
STEM LNG GII 24MMX100MM
|
Facility
|
IP
|
$8,811.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.46 |
| Max. Negotiated Rate |
$8,459.07 |
| Rate for Payer: Aetna Commercial |
$6,784.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.99
|
| Rate for Payer: Cash Price |
$4,405.76
|
| Rate for Payer: Cigna Commercial |
$7,313.57
|
| Rate for Payer: First Health Commercial |
$8,370.95
|
| Rate for Payer: Humana Commercial |
$7,489.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,754.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,049.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.96
|
| Rate for Payer: PHCS Commercial |
$8,459.07
|
| Rate for Payer: United Healthcare All Payer |
$7,754.15
|
|
|
STEM LPS CEM 10*100MM STR
|
Facility
|
IP
|
$23,441.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,032.44 |
| Max. Negotiated Rate |
$22,503.79 |
| Rate for Payer: Aetna Commercial |
$18,049.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,284.33
|
| Rate for Payer: Cash Price |
$11,720.73
|
| Rate for Payer: Cigna Commercial |
$19,456.40
|
| Rate for Payer: First Health Commercial |
$22,269.38
|
| Rate for Payer: Humana Commercial |
$19,925.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,221.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,299.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,032.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,628.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,581.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,753.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,394.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,174.60
|
| Rate for Payer: PHCS Commercial |
$22,503.79
|
| Rate for Payer: United Healthcare All Payer |
$20,628.48
|
|
|
STEM LPS CEM 10*100MM STR
|
Facility
|
OP
|
$23,441.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,032.44 |
| Max. Negotiated Rate |
$22,503.79 |
| Rate for Payer: Aetna Commercial |
$18,049.92
|
| Rate for Payer: Anthem Medicaid |
$8,061.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,284.33
|
| Rate for Payer: Cash Price |
$11,720.73
|
| Rate for Payer: Cigna Commercial |
$19,456.40
|
| Rate for Payer: First Health Commercial |
$22,269.38
|
| Rate for Payer: Humana Commercial |
$19,925.23
|
| Rate for Payer: Humana KY Medicaid |
$8,061.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8,143.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,221.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,299.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,032.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,223.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,628.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,581.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,753.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,394.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,174.60
|
| Rate for Payer: PHCS Commercial |
$22,503.79
|
| Rate for Payer: United Healthcare All Payer |
$20,628.48
|
|
