|
STEM WAGNER CONE 135^ 18MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 18MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 19MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 19MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 20MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 20MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 21MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 21MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 22MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 22MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 23MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 23MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 24MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 135^ 24MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER DIST PROV SZ 13
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 13
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 14
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 14
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 15
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 15
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 16
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 16
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 17
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 17
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 18
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
