|
TM HUM STEM 48 10*170
|
Facility
|
IP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 48 11*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 11*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 12*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 12*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 12*170
|
Facility
|
IP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 48 12*170
|
Facility
|
OP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem Medicaid |
$7,869.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Humana KY Medicaid |
$7,869.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,949.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,027.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 48 13*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 13*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 14*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 14*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 14*170
|
Facility
|
IP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 48 14*170
|
Facility
|
OP
|
$22,882.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,974.67 |
| Max. Negotiated Rate |
$21,966.82 |
| Rate for Payer: Aetna Commercial |
$17,619.22
|
| Rate for Payer: Anthem Medicaid |
$7,869.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,848.04
|
| Rate for Payer: Cash Price |
$11,441.05
|
| Rate for Payer: Cigna Commercial |
$18,992.14
|
| Rate for Payer: First Health Commercial |
$21,738.00
|
| Rate for Payer: Humana Commercial |
$19,449.78
|
| Rate for Payer: Humana KY Medicaid |
$7,869.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,949.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,886.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,864.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,027.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,136.25
|
| Rate for Payer: Ohio Health Group HMO |
$17,161.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,093.45
|
| Rate for Payer: PHCS Commercial |
$21,966.82
|
| Rate for Payer: United Healthcare All Payer |
$20,136.25
|
|
|
TM HUM STEM 48 15*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 15*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 16*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 16*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 17*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 17*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 18*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 18*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 6*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 6*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 8*130
|
Facility
|
OP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem Medicaid |
$7,304.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Humana KY Medicaid |
$7,304.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7,378.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,450.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
|
TM HUM STEM 48 8*130
|
Facility
|
IP
|
$21,239.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.15 |
| Max. Negotiated Rate |
$20,390.02 |
| Rate for Payer: Aetna Commercial |
$16,354.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,566.89
|
| Rate for Payer: Cash Price |
$10,619.80
|
| Rate for Payer: Cigna Commercial |
$17,628.87
|
| Rate for Payer: First Health Commercial |
$20,177.62
|
| Rate for Payer: Humana Commercial |
$18,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,416.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,674.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,371.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,690.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,929.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,247.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,761.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,584.28
|
| Rate for Payer: PHCS Commercial |
$20,390.02
|
| Rate for Payer: United Healthcare All Payer |
$18,690.85
|
|
