|
11 LNG REV POL+20 L IMPLT STEM
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
11 LNG REV POL+20 R IMPLT STEM
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
11 LNG REV POL+20 R IMPLT STEM
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
11 STEM PRIMARY HO
|
Facility
|
IP
|
$18,000.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,340.08 |
| Max. Negotiated Rate |
$17,280.58 |
| Rate for Payer: Aetna Commercial |
$13,860.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,040.47
|
| Rate for Payer: Cash Price |
$9,000.30
|
| Rate for Payer: Cigna Commercial |
$14,940.50
|
| Rate for Payer: First Health Commercial |
$17,100.57
|
| Rate for Payer: Humana Commercial |
$15,300.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,760.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,284.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,400.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,840.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,500.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,580.19
|
| Rate for Payer: PHCS Commercial |
$17,280.58
|
| Rate for Payer: United Healthcare All Payer |
$15,840.53
|
|
|
11 STEM PRIMARY HO
|
Facility
|
OP
|
$18,000.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,340.08 |
| Max. Negotiated Rate |
$17,280.58 |
| Rate for Payer: Aetna Commercial |
$13,860.46
|
| Rate for Payer: Anthem Medicaid |
$6,190.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,040.47
|
| Rate for Payer: Cash Price |
$9,000.30
|
| Rate for Payer: Cigna Commercial |
$14,940.50
|
| Rate for Payer: First Health Commercial |
$17,100.57
|
| Rate for Payer: Humana Commercial |
$15,300.51
|
| Rate for Payer: Humana KY Medicaid |
$6,190.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6,253.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,760.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,284.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,400.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,314.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,840.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,500.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,580.19
|
| Rate for Payer: PHCS Commercial |
$17,280.58
|
| Rate for Payer: United Healthcare All Payer |
$15,840.53
|
|
|
11 STEM PRIMARY SO
|
Facility
|
OP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
11 STEM PRIMARY SO
|
Facility
|
IP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
1.2100805E7
|
Facility
|
IP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
1.2100805E7
|
Facility
|
OP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem Medicaid |
$590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Humana KY Medicaid |
$590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$596.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
12X120MM OVATION IX
|
Facility
|
IP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
12X120MM OVATION IX
|
Facility
|
OP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem Medicaid |
$8,804.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Humana KY Medicaid |
$8,804.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,893.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,980.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
13 SLV MD CONE 1 SPT TALL SLOT
|
Facility
|
OP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
13 SLV MD CONE 1 SPT TALL SLOT
|
Facility
|
IP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
13 SLV MD CONE 2 SPT TALL SLOT
|
Facility
|
OP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
13 SLV MD CONE 2 SPT TALL SLOT
|
Facility
|
IP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
13 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
13 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
13 SLV SM CONE 2 SPT TALL SLOT
|
Facility
|
IP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
13 SLV SM CONE 2 SPT TALL SLOT
|
Facility
|
OP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.31 |
| Max. Negotiated Rate |
$16,972.13 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
13 STEM LNG REV POL +0 L
|
Facility
|
OP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem Medicaid |
$6,921.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Humana KY Medicaid |
$6,921.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,991.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,060.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
13 STEM LNG REV POL +0 L
|
Facility
|
IP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
13 STEM LNG REV POL +0 R
|
Facility
|
IP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
13 STEM LNG REV POL +0 R
|
Facility
|
OP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem Medicaid |
$6,921.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Humana KY Medicaid |
$6,921.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,991.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,060.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
13 STEM LNG REV POL +10 L
|
Facility
|
IP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
13 STEM LNG REV POL +10 L
|
Facility
|
OP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem Medicaid |
$6,921.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Humana KY Medicaid |
$6,921.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,991.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,060.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
