|
STEM LPS CEM 11*100MM STR
|
Facility
|
IP
|
$27,327.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,198.25 |
| Max. Negotiated Rate |
$26,234.40 |
| Rate for Payer: Aetna Commercial |
$21,042.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,315.45
|
| Rate for Payer: Cash Price |
$13,663.75
|
| Rate for Payer: Cigna Commercial |
$22,681.83
|
| Rate for Payer: First Health Commercial |
$25,961.12
|
| Rate for Payer: Humana Commercial |
$23,228.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,408.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,198.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,048.20
|
| Rate for Payer: Ohio Health Group HMO |
$20,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,774.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,855.97
|
| Rate for Payer: PHCS Commercial |
$26,234.40
|
| Rate for Payer: United Healthcare All Payer |
$24,048.20
|
|
|
STEM LPS CEM 11*100MM STR
|
Facility
|
OP
|
$27,327.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,198.25 |
| Max. Negotiated Rate |
$26,234.40 |
| Rate for Payer: Aetna Commercial |
$21,042.17
|
| Rate for Payer: Anthem Medicaid |
$9,397.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,315.45
|
| Rate for Payer: Cash Price |
$13,663.75
|
| Rate for Payer: Cigna Commercial |
$22,681.83
|
| Rate for Payer: First Health Commercial |
$25,961.12
|
| Rate for Payer: Humana Commercial |
$23,228.38
|
| Rate for Payer: Humana KY Medicaid |
$9,397.93
|
| Rate for Payer: Kentucky WC Medicaid |
$9,493.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,408.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,198.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,586.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,048.20
|
| Rate for Payer: Ohio Health Group HMO |
$20,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,774.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,855.97
|
| Rate for Payer: PHCS Commercial |
$26,234.40
|
| Rate for Payer: United Healthcare All Payer |
$24,048.20
|
|
|
STEM LPS CEM 12*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 12*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
|
|
|
STEM LPS CEM 12*125MM STR
|
Facility
|
IP
|
$28,445.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,533.50 |
| Max. Negotiated Rate |
$27,307.20 |
| Rate for Payer: Aetna Commercial |
$21,902.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,187.10
|
| Rate for Payer: Cash Price |
$14,222.50
|
| Rate for Payer: Cigna Commercial |
$23,609.35
|
| Rate for Payer: First Health Commercial |
$27,022.75
|
| Rate for Payer: Humana Commercial |
$24,178.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,324.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,992.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,533.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,031.60
|
| Rate for Payer: Ohio Health Group HMO |
$21,333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,747.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,627.05
|
| Rate for Payer: PHCS Commercial |
$27,307.20
|
| Rate for Payer: United Healthcare All Payer |
$25,031.60
|
|
|
STEM LPS CEM 12*125MM STR
|
Facility
|
OP
|
$28,445.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,533.50 |
| Max. Negotiated Rate |
$27,307.20 |
| Rate for Payer: Aetna Commercial |
$21,902.65
|
| Rate for Payer: Anthem Medicaid |
$9,782.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,187.10
|
| Rate for Payer: Cash Price |
$14,222.50
|
| Rate for Payer: Cigna Commercial |
$23,609.35
|
| Rate for Payer: First Health Commercial |
$27,022.75
|
| Rate for Payer: Humana Commercial |
$24,178.25
|
| Rate for Payer: Humana KY Medicaid |
$9,782.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,881.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,324.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,992.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,533.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,978.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,031.60
|
| Rate for Payer: Ohio Health Group HMO |
$21,333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,747.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,627.05
|
| Rate for Payer: PHCS Commercial |
$27,307.20
|
| Rate for Payer: United Healthcare All Payer |
$25,031.60
|
|
|
STEM LPS CEM 13*125MM STR
|
Facility
|
IP
|
$25,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,575.00 |
| Max. Negotiated Rate |
$24,240.00 |
| Rate for Payer: Aetna Commercial |
$19,442.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,695.00
|
| Rate for Payer: Cash Price |
$12,625.00
|
| Rate for Payer: Cigna Commercial |
$20,957.50
|
| Rate for Payer: First Health Commercial |
$23,987.50
|
| Rate for Payer: Humana Commercial |
$21,462.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,705.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,634.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,575.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,220.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,967.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,422.50
|
| Rate for Payer: PHCS Commercial |
$24,240.00
|
| Rate for Payer: United Healthcare All Payer |
$22,220.00
|
|
|
STEM LPS CEM 13*125MM STR
|
Facility
|
OP
|
$25,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,575.00 |
| Max. Negotiated Rate |
$24,240.00 |
| Rate for Payer: Aetna Commercial |
$19,442.50
|
| Rate for Payer: Anthem Medicaid |
$8,683.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,695.00
|
| Rate for Payer: Cash Price |
$12,625.00
|
| Rate for Payer: Cigna Commercial |
$20,957.50
|
| Rate for Payer: First Health Commercial |
$23,987.50
|
| Rate for Payer: Humana Commercial |
$21,462.50
|
| Rate for Payer: Humana KY Medicaid |
$8,683.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,771.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,705.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,634.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,575.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,857.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,220.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,967.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,422.50
|
| Rate for Payer: PHCS Commercial |
$24,240.00
|
| Rate for Payer: United Healthcare All Payer |
$22,220.00
|
|
|
STEM LPS CEM 14*125MM 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 14*125MM 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
|
|
|
STEM LPS CEM 15*125MM STR
|
Facility
|
OP
|
$26,142.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,842.81 |
| Max. Negotiated Rate |
$25,096.98 |
| Rate for Payer: Aetna Commercial |
$20,129.87
|
| Rate for Payer: Anthem Medicaid |
$8,990.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,391.30
|
| Rate for Payer: Cash Price |
$13,071.34
|
| Rate for Payer: Cigna Commercial |
$21,698.43
|
| Rate for Payer: First Health Commercial |
$24,835.56
|
| Rate for Payer: Humana Commercial |
$22,221.29
|
| Rate for Payer: Humana KY Medicaid |
$8,990.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9,081.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,437.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,293.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,842.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,170.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,005.57
|
| Rate for Payer: Ohio Health Group HMO |
$19,607.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,744.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,038.46
|
| Rate for Payer: PHCS Commercial |
$25,096.98
|
| Rate for Payer: United Healthcare All Payer |
$23,005.57
|
|
|
STEM LPS CEM 15*125MM STR
|
Facility
|
IP
|
$26,142.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,842.81 |
| Max. Negotiated Rate |
$25,096.98 |
| Rate for Payer: Aetna Commercial |
$20,129.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,391.30
|
| Rate for Payer: Cash Price |
$13,071.34
|
| Rate for Payer: Cigna Commercial |
$21,698.43
|
| Rate for Payer: First Health Commercial |
$24,835.56
|
| Rate for Payer: Humana Commercial |
$22,221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,437.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,293.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,842.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,005.57
|
| Rate for Payer: Ohio Health Group HMO |
$19,607.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,744.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,038.46
|
| Rate for Payer: PHCS Commercial |
$25,096.98
|
| Rate for Payer: United Healthcare All Payer |
$23,005.57
|
|
|
STEM LPS CEM 16*125MM STR
|
Facility
|
OP
|
$26,142.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,842.81 |
| Max. Negotiated Rate |
$25,096.98 |
| Rate for Payer: Aetna Commercial |
$20,129.87
|
| Rate for Payer: Anthem Medicaid |
$8,990.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,391.30
|
| Rate for Payer: Cash Price |
$13,071.34
|
| Rate for Payer: Cigna Commercial |
$21,698.43
|
| Rate for Payer: First Health Commercial |
$24,835.56
|
| Rate for Payer: Humana Commercial |
$22,221.29
|
| Rate for Payer: Humana KY Medicaid |
$8,990.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9,081.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,437.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,293.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,842.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,170.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,005.57
|
| Rate for Payer: Ohio Health Group HMO |
$19,607.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,744.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,038.46
|
| Rate for Payer: PHCS Commercial |
$25,096.98
|
| Rate for Payer: United Healthcare All Payer |
$23,005.57
|
|
|
STEM LPS CEM 16*125MM STR
|
Facility
|
IP
|
$26,142.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,842.81 |
| Max. Negotiated Rate |
$25,096.98 |
| Rate for Payer: Aetna Commercial |
$20,129.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,391.30
|
| Rate for Payer: Cash Price |
$13,071.34
|
| Rate for Payer: Cigna Commercial |
$21,698.43
|
| Rate for Payer: First Health Commercial |
$24,835.56
|
| Rate for Payer: Humana Commercial |
$22,221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,437.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,293.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,842.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,005.57
|
| Rate for Payer: Ohio Health Group HMO |
$19,607.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,744.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,038.46
|
| Rate for Payer: PHCS Commercial |
$25,096.98
|
| Rate for Payer: United Healthcare All Payer |
$23,005.57
|
|
|
STEM LPS CEM 17*125MM STR
|
Facility
|
OP
|
$27,327.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,198.25 |
| Max. Negotiated Rate |
$26,234.40 |
| Rate for Payer: Aetna Commercial |
$21,042.17
|
| Rate for Payer: Anthem Medicaid |
$9,397.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,315.45
|
| Rate for Payer: Cash Price |
$13,663.75
|
| Rate for Payer: Cigna Commercial |
$22,681.83
|
| Rate for Payer: First Health Commercial |
$25,961.12
|
| Rate for Payer: Humana Commercial |
$23,228.38
|
| Rate for Payer: Humana KY Medicaid |
$9,397.93
|
| Rate for Payer: Kentucky WC Medicaid |
$9,493.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,408.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,198.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,586.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,048.20
|
| Rate for Payer: Ohio Health Group HMO |
$20,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,774.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,855.97
|
| Rate for Payer: PHCS Commercial |
$26,234.40
|
| Rate for Payer: United Healthcare All Payer |
$24,048.20
|
|
|
STEM LPS CEM 17*125MM STR
|
Facility
|
IP
|
$27,327.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,198.25 |
| Max. Negotiated Rate |
$26,234.40 |
| Rate for Payer: Aetna Commercial |
$21,042.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,315.45
|
| Rate for Payer: Cash Price |
$13,663.75
|
| Rate for Payer: Cigna Commercial |
$22,681.83
|
| Rate for Payer: First Health Commercial |
$25,961.12
|
| Rate for Payer: Humana Commercial |
$23,228.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,408.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,198.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,048.20
|
| Rate for Payer: Ohio Health Group HMO |
$20,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,774.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,855.97
|
| Rate for Payer: PHCS Commercial |
$26,234.40
|
| Rate for Payer: United Healthcare All Payer |
$24,048.20
|
|
|
STEM LPS CEM 9*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
|
|
|
STEM LPS CEM 9*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 FEM 11*150MM BOW
|
Facility
|
IP
|
$23,767.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,130.31 |
| Max. Negotiated Rate |
$22,816.99 |
| Rate for Payer: Aetna Commercial |
$18,301.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,538.81
|
| Rate for Payer: Cash Price |
$11,883.85
|
| Rate for Payer: Cigna Commercial |
$19,727.19
|
| Rate for Payer: First Health Commercial |
$22,579.31
|
| Rate for Payer: Humana Commercial |
$20,202.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,489.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,540.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,130.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,915.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,825.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,014.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,677.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,399.71
|
| Rate for Payer: PHCS Commercial |
$22,816.99
|
| Rate for Payer: United Healthcare All Payer |
$20,915.58
|
|
|
STEM LPS CEM FEM 11*150MM BOW
|
Facility
|
OP
|
$23,767.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,130.31 |
| Max. Negotiated Rate |
$22,816.99 |
| Rate for Payer: Aetna Commercial |
$18,301.13
|
| Rate for Payer: Anthem Medicaid |
$8,173.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,538.81
|
| Rate for Payer: Cash Price |
$11,883.85
|
| Rate for Payer: Cigna Commercial |
$19,727.19
|
| Rate for Payer: First Health Commercial |
$22,579.31
|
| Rate for Payer: Humana Commercial |
$20,202.54
|
| Rate for Payer: Humana KY Medicaid |
$8,173.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,256.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,489.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,540.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,130.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,337.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,915.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,825.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,014.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,677.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,399.71
|
| Rate for Payer: PHCS Commercial |
$22,816.99
|
| Rate for Payer: United Healthcare All Payer |
$20,915.58
|
|
|
STEM LPS CEM FEM 11*200MM BOW
|
Facility
|
OP
|
$11,165.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,349.68 |
| Max. Negotiated Rate |
$10,718.98 |
| Rate for Payer: Aetna Commercial |
$8,597.51
|
| Rate for Payer: Anthem Medicaid |
$3,839.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,709.17
|
| Rate for Payer: Cash Price |
$5,582.80
|
| Rate for Payer: Cigna Commercial |
$9,267.45
|
| Rate for Payer: First Health Commercial |
$10,607.32
|
| Rate for Payer: Humana Commercial |
$9,490.76
|
| Rate for Payer: Humana KY Medicaid |
$3,839.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,878.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,155.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,240.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,349.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,916.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,825.73
|
| Rate for Payer: Ohio Health Group HMO |
$8,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,932.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,714.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,704.26
|
| Rate for Payer: PHCS Commercial |
$10,718.98
|
| Rate for Payer: United Healthcare All Payer |
$9,825.73
|
|
|
STEM LPS CEM FEM 11*200MM BOW
|
Facility
|
IP
|
$11,165.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,349.68 |
| Max. Negotiated Rate |
$10,718.98 |
| Rate for Payer: Aetna Commercial |
$8,597.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,709.17
|
| Rate for Payer: Cash Price |
$5,582.80
|
| Rate for Payer: Cigna Commercial |
$9,267.45
|
| Rate for Payer: First Health Commercial |
$10,607.32
|
| Rate for Payer: Humana Commercial |
$9,490.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,155.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,240.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,349.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,825.73
|
| Rate for Payer: Ohio Health Group HMO |
$8,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,932.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,714.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,704.26
|
| Rate for Payer: PHCS Commercial |
$10,718.98
|
| Rate for Payer: United Healthcare All Payer |
$9,825.73
|
|
|
STEM LPS CEM FEM 12*150MM BOW
|
Facility
|
OP
|
$27,408.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,222.44 |
| Max. Negotiated Rate |
$26,311.80 |
| Rate for Payer: Aetna Commercial |
$21,104.25
|
| Rate for Payer: Anthem Medicaid |
$9,425.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,378.33
|
| Rate for Payer: Cash Price |
$13,704.06
|
| Rate for Payer: Cigna Commercial |
$22,748.74
|
| Rate for Payer: First Health Commercial |
$26,037.71
|
| Rate for Payer: Humana Commercial |
$23,296.90
|
| Rate for Payer: Humana KY Medicaid |
$9,425.65
|
| Rate for Payer: Kentucky WC Medicaid |
$9,521.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,474.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,227.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,222.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,119.15
|
| Rate for Payer: Ohio Health Group HMO |
$20,556.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,845.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,911.60
|
| Rate for Payer: PHCS Commercial |
$26,311.80
|
| Rate for Payer: United Healthcare All Payer |
$24,119.15
|
|
|
STEM LPS CEM FEM 12*150MM BOW
|
Facility
|
IP
|
$27,408.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,222.44 |
| Max. Negotiated Rate |
$26,311.80 |
| Rate for Payer: Aetna Commercial |
$21,104.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,378.33
|
| Rate for Payer: Cash Price |
$13,704.06
|
| Rate for Payer: Cigna Commercial |
$22,748.74
|
| Rate for Payer: First Health Commercial |
$26,037.71
|
| Rate for Payer: Humana Commercial |
$23,296.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,474.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,227.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,222.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,119.15
|
| Rate for Payer: Ohio Health Group HMO |
$20,556.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,845.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,911.60
|
| Rate for Payer: PHCS Commercial |
$26,311.80
|
| Rate for Payer: United Healthcare All Payer |
$24,119.15
|
|
|
STEM LPS CEM FEM 13*150MM BOW
|
Facility
|
IP
|
$36,758.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,027.62 |
| Max. Negotiated Rate |
$35,288.40 |
| Rate for Payer: Aetna Commercial |
$28,304.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,671.83
|
| Rate for Payer: Cash Price |
$18,379.38
|
| Rate for Payer: Cigna Commercial |
$30,509.76
|
| Rate for Payer: First Health Commercial |
$34,920.81
|
| Rate for Payer: Humana Commercial |
$31,244.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,142.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,127.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,027.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,347.70
|
| Rate for Payer: Ohio Health Group HMO |
$27,569.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,407.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,980.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,363.54
|
| Rate for Payer: PHCS Commercial |
$35,288.40
|
| Rate for Payer: United Healthcare All Payer |
$32,347.70
|
|
