|
TM HUM STEM 42 DEG 15*130
|
Facility
|
IP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 16*130
|
Facility
|
OP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem Medicaid |
$7,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Humana KY Medicaid |
$7,711.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 16*130
|
Facility
|
IP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 17*130
|
Facility
|
OP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem Medicaid |
$7,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Humana KY Medicaid |
$7,711.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 17*130
|
Facility
|
IP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 18*130
|
Facility
|
IP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 18*130
|
Facility
|
OP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem Medicaid |
$7,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Humana KY Medicaid |
$7,711.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 6*130
|
Facility
|
OP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem Medicaid |
$7,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Humana KY Medicaid |
$7,711.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 6*130
|
Facility
|
IP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 8*130
|
Facility
|
IP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 8*130
|
Facility
|
OP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem Medicaid |
$7,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Humana KY Medicaid |
$7,711.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 8*170
|
Facility
|
OP
|
$24,173.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,251.90 |
| Max. Negotiated Rate |
$23,206.08 |
| Rate for Payer: Aetna Commercial |
$18,613.21
|
| Rate for Payer: Anthem Medicaid |
$8,313.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,854.94
|
| Rate for Payer: Cash Price |
$12,086.50
|
| Rate for Payer: Cigna Commercial |
$20,063.59
|
| Rate for Payer: First Health Commercial |
$22,964.35
|
| Rate for Payer: Humana Commercial |
$20,547.05
|
| Rate for Payer: Humana KY Medicaid |
$8,313.09
|
| Rate for Payer: Kentucky WC Medicaid |
$8,397.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,821.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,839.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,251.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,479.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,272.24
|
| Rate for Payer: Ohio Health Group HMO |
$18,129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,338.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,030.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,679.37
|
| Rate for Payer: PHCS Commercial |
$23,206.08
|
| Rate for Payer: United Healthcare All Payer |
$21,272.24
|
|
|
TM HUM STEM 42 DEG 8*170
|
Facility
|
IP
|
$24,173.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,251.90 |
| Max. Negotiated Rate |
$23,206.08 |
| Rate for Payer: Aetna Commercial |
$18,613.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,854.94
|
| Rate for Payer: Cash Price |
$12,086.50
|
| Rate for Payer: Cigna Commercial |
$20,063.59
|
| Rate for Payer: First Health Commercial |
$22,964.35
|
| Rate for Payer: Humana Commercial |
$20,547.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,821.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,839.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,251.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,272.24
|
| Rate for Payer: Ohio Health Group HMO |
$18,129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,338.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,030.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,679.37
|
| Rate for Payer: PHCS Commercial |
$23,206.08
|
| Rate for Payer: United Healthcare All Payer |
$21,272.24
|
|
|
TM HUM STEM 42 DEG 9*130
|
Facility
|
OP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem Medicaid |
$7,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Humana KY Medicaid |
$7,711.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 42 DEG 9*130
|
Facility
|
IP
|
$22,424.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,727.20 |
| Max. Negotiated Rate |
$21,527.04 |
| Rate for Payer: Aetna Commercial |
$17,266.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.72
|
| Rate for Payer: Cash Price |
$11,212.00
|
| Rate for Payer: Cigna Commercial |
$18,611.92
|
| Rate for Payer: First Health Commercial |
$21,302.80
|
| Rate for Payer: Humana Commercial |
$19,060.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,727.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,733.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.56
|
| Rate for Payer: PHCS Commercial |
$21,527.04
|
| Rate for Payer: United Healthcare All Payer |
$19,733.12
|
|
|
TM HUM STEM 48 10*170
|
Facility
|
IP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 48 10*170
|
Facility
|
OP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem Medicaid |
$8,108.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Humana KY Medicaid |
$8,108.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,190.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,270.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 48 11*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 48 11*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 48 12*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 48 12*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 48 12*170
|
Facility
|
IP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 48 12*170
|
Facility
|
OP
|
$23,577.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,073.25 |
| Max. Negotiated Rate |
$22,634.40 |
| Rate for Payer: Aetna Commercial |
$18,154.67
|
| Rate for Payer: Anthem Medicaid |
$8,108.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,390.45
|
| Rate for Payer: Cash Price |
$11,788.75
|
| Rate for Payer: Cigna Commercial |
$19,569.33
|
| Rate for Payer: First Health Commercial |
$22,398.62
|
| Rate for Payer: Humana Commercial |
$20,040.88
|
| Rate for Payer: Humana KY Medicaid |
$8,108.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,190.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,073.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,270.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,748.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,683.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,512.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,268.48
|
| Rate for Payer: PHCS Commercial |
$22,634.40
|
| Rate for Payer: United Healthcare All Payer |
$20,748.20
|
|
|
TM HUM STEM 48 13*130
|
Facility
|
OP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem Medicaid |
$7,527.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Humana KY Medicaid |
$7,527.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,604.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,679.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
|
TM HUM STEM 48 13*130
|
Facility
|
IP
|
$21,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,567.00 |
| Max. Negotiated Rate |
$21,014.40 |
| Rate for Payer: Aetna Commercial |
$16,855.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,074.20
|
| Rate for Payer: Cash Price |
$10,945.00
|
| Rate for Payer: Cigna Commercial |
$18,168.70
|
| Rate for Payer: First Health Commercial |
$20,795.50
|
| Rate for Payer: Humana Commercial |
$18,606.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,949.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,154.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,263.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,044.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,104.10
|
| Rate for Payer: PHCS Commercial |
$21,014.40
|
| Rate for Payer: United Healthcare All Payer |
$19,263.20
|
|
