|
STEM LPS CEM FEM 13*150MM BOW
|
Facility
|
OP
|
$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 Medicaid |
$12,641.33
|
| 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: Humana KY Medicaid |
$12,641.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,769.99
|
| 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: Molina Healthcare Medicaid |
$12,894.97
|
| 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
|
|
|
STEM LPS CEM FEM 13*200MM 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 13*200MM 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 14*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 14*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 15*150MM BOW
|
Facility
|
OP
|
$26,281.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,884.38 |
| Max. Negotiated Rate |
$25,230.00 |
| Rate for Payer: Aetna Commercial |
$20,236.56
|
| Rate for Payer: Anthem Medicaid |
$9,038.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,499.38
|
| Rate for Payer: Cash Price |
$13,140.62
|
| Rate for Payer: Cigna Commercial |
$21,813.44
|
| Rate for Payer: First Health Commercial |
$24,967.19
|
| Rate for Payer: Humana Commercial |
$22,339.06
|
| Rate for Payer: Humana KY Medicaid |
$9,038.12
|
| Rate for Payer: Kentucky WC Medicaid |
$9,130.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,550.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,395.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,884.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,219.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,127.50
|
| Rate for Payer: Ohio Health Group HMO |
$19,710.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,864.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,134.06
|
| Rate for Payer: PHCS Commercial |
$25,230.00
|
| Rate for Payer: United Healthcare All Payer |
$23,127.50
|
|
|
STEM LPS CEM FEM 15*150MM BOW
|
Facility
|
IP
|
$26,281.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,884.38 |
| Max. Negotiated Rate |
$25,230.00 |
| Rate for Payer: Aetna Commercial |
$20,236.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,499.38
|
| Rate for Payer: Cash Price |
$13,140.62
|
| Rate for Payer: Cigna Commercial |
$21,813.44
|
| Rate for Payer: First Health Commercial |
$24,967.19
|
| Rate for Payer: Humana Commercial |
$22,339.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,550.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,395.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,884.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,127.50
|
| Rate for Payer: Ohio Health Group HMO |
$19,710.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,864.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,134.06
|
| Rate for Payer: PHCS Commercial |
$25,230.00
|
| Rate for Payer: United Healthcare All Payer |
$23,127.50
|
|
|
STEM LPS CEM FEM 15*200MM BOW
|
Facility
|
OP
|
$30,106.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,031.88 |
| Max. Negotiated Rate |
$28,902.00 |
| Rate for Payer: Aetna Commercial |
$23,181.81
|
| Rate for Payer: Anthem Medicaid |
$10,353.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,482.88
|
| Rate for Payer: Cash Price |
$15,053.12
|
| Rate for Payer: Cigna Commercial |
$24,988.19
|
| Rate for Payer: First Health Commercial |
$28,600.94
|
| Rate for Payer: Humana Commercial |
$25,590.31
|
| Rate for Payer: Humana KY Medicaid |
$10,353.54
|
| Rate for Payer: Kentucky WC Medicaid |
$10,458.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,687.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,218.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,031.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,561.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,493.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,579.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,192.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,773.31
|
| Rate for Payer: PHCS Commercial |
$28,902.00
|
| Rate for Payer: United Healthcare All Payer |
$26,493.50
|
|
|
STEM LPS CEM FEM 15*200MM BOW
|
Facility
|
IP
|
$30,106.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,031.88 |
| Max. Negotiated Rate |
$28,902.00 |
| Rate for Payer: Aetna Commercial |
$23,181.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,482.88
|
| Rate for Payer: Cash Price |
$15,053.12
|
| Rate for Payer: Cigna Commercial |
$24,988.19
|
| Rate for Payer: First Health Commercial |
$28,600.94
|
| Rate for Payer: Humana Commercial |
$25,590.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,687.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,218.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,031.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,493.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,579.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,192.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,773.31
|
| Rate for Payer: PHCS Commercial |
$28,902.00
|
| Rate for Payer: United Healthcare All Payer |
$26,493.50
|
|
|
STEM LPS CEM FEM 16*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 16*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 17*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 17*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 17*200MM 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 17*200MM 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 PC FEM 12.5*150MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 12.5*150MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 12.5*200MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 12.5*200MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 13.5*150MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 13.5*150MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 14.5*150MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 14.5*150MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 14.5*200MM BOW
|
Facility
|
IP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
|
STEM LPS PC FEM 14.5*200MM BOW
|
Facility
|
OP
|
$25,035.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,510.60 |
| Max. Negotiated Rate |
$24,033.94 |
| Rate for Payer: Aetna Commercial |
$19,277.22
|
| Rate for Payer: Anthem Medicaid |
$8,609.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,527.57
|
| Rate for Payer: Cash Price |
$12,517.67
|
| Rate for Payer: Cigna Commercial |
$20,779.34
|
| Rate for Payer: First Health Commercial |
$23,783.58
|
| Rate for Payer: Humana Commercial |
$21,280.05
|
| Rate for Payer: Humana KY Medicaid |
$8,609.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,697.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,528.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,510.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,782.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,031.11
|
| Rate for Payer: Ohio Health Group HMO |
$18,776.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,028.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,780.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,274.39
|
| Rate for Payer: PHCS Commercial |
$24,033.94
|
| Rate for Payer: United Healthcare All Payer |
$22,031.11
|
|
