|
TM HUM STEM 48 DEG 11*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 48 DEG 12*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 DEG 12*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 48 DEG 12*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 48 DEG 12*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 48 DEG 13*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 48 DEG 13*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 DEG 14*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 DEG 14*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 48 DEG 14*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 48 DEG 14*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 48 DEG 15*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 48 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 48 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 48 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 48 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 48 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 48 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 48 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 48 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 48 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 48 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 48 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 48 DEG 9*130
|
Facility
|
IP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
|
TM HUM STEM 48 DEG 9*130
|
Facility
|
OP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem Medicaid |
$6,227.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Humana KY Medicaid |
$6,227.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,290.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,352.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
