|
STEMNTAL FEM/TIB M/F PROV 60MM
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTAL FEM/TIB M/F PROV 60MM
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTAL FEM/TIB M/F PROV 80MM
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTAL FEM/TIB M/F PROV 80MM
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTL FEM/TIB M/F PROV 100MM
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTL FEM/TIB M/F PROV 100MM
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTL FEM/TIB M/F PROV 120MM
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTL FEM/TIB M/F PROV 120MM
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTL FEM/TIB M/F PROV 140MM
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEMNTL FEM/TIB M/F PROV 140MM
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
STEM NXGN OFFST EXT 11MMX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 11MMX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 12MMX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 12MMX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 12MMX200MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 12MMX200MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 13MMX200MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 13MMX200MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 13MX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 13MX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 14MMX200MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 14MMX200MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 14MX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 14MX145MM
|
Facility
|
IP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
|
STEM NXGN OFFST EXT 15MMX145MM
|
Facility
|
OP
|
$8,330.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.07 |
| Max. Negotiated Rate |
$7,997.03 |
| Rate for Payer: Aetna Commercial |
$6,414.28
|
| Rate for Payer: Anthem Medicaid |
$2,864.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.59
|
| Rate for Payer: Cash Price |
$4,165.12
|
| Rate for Payer: Cigna Commercial |
$6,914.10
|
| Rate for Payer: First Health Commercial |
$7,913.73
|
| Rate for Payer: Humana Commercial |
$7,080.70
|
| Rate for Payer: Humana KY Medicaid |
$2,864.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,664.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,247.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.87
|
| Rate for Payer: PHCS Commercial |
$7,997.03
|
| Rate for Payer: United Healthcare All Payer |
$7,330.61
|
|
