|
13 STEM LNG REV POL +10 L
|
Facility
|
OP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem Medicaid |
$7,134.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Humana KY Medicaid |
$7,134.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,207.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,277.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM LNG REV POL +10 L
|
Facility
|
IP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM LNG REV POL +10 R
|
Facility
|
OP
|
$25,667.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,700.32 |
| Max. Negotiated Rate |
$24,641.04 |
| Rate for Payer: Aetna Commercial |
$19,764.17
|
| Rate for Payer: Anthem Medicaid |
$8,827.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,020.85
|
| Rate for Payer: Cash Price |
$12,833.88
|
| Rate for Payer: Cigna Commercial |
$21,304.23
|
| Rate for Payer: First Health Commercial |
$24,384.36
|
| Rate for Payer: Humana Commercial |
$21,817.59
|
| Rate for Payer: Humana KY Medicaid |
$8,827.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,916.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,047.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,942.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,700.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,004.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,587.62
|
| Rate for Payer: Ohio Health Group HMO |
$19,250.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,534.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,330.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,710.75
|
| Rate for Payer: PHCS Commercial |
$24,641.04
|
| Rate for Payer: United Healthcare All Payer |
$22,587.62
|
|
|
13 STEM LNG REV POL +10 R
|
Facility
|
IP
|
$25,667.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,700.32 |
| Max. Negotiated Rate |
$24,641.04 |
| Rate for Payer: Aetna Commercial |
$19,764.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,020.85
|
| Rate for Payer: Cash Price |
$12,833.88
|
| Rate for Payer: Cigna Commercial |
$21,304.23
|
| Rate for Payer: First Health Commercial |
$24,384.36
|
| Rate for Payer: Humana Commercial |
$21,817.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,047.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,942.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,700.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,587.62
|
| Rate for Payer: Ohio Health Group HMO |
$19,250.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,534.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,330.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,710.75
|
| Rate for Payer: PHCS Commercial |
$24,641.04
|
| Rate for Payer: United Healthcare All Payer |
$22,587.62
|
|
|
13 STEM PRIMARY HO
|
Facility
|
OP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem Medicaid |
$6,277.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Humana KY Medicaid |
$6,277.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,341.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 STEM PRIMARY HO
|
Facility
|
IP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 STEM PRIMARY SO
|
Facility
|
OP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem Medicaid |
$6,277.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Humana KY Medicaid |
$6,277.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,341.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 STEM PRIMARY SO
|
Facility
|
IP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 STEM SH REV POL +0
|
Facility
|
IP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM SH REV POL +0
|
Facility
|
OP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem Medicaid |
$7,134.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Humana KY Medicaid |
$7,134.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,207.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,277.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM SH REV POL +10
|
Facility
|
IP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM SH REV POL +10
|
Facility
|
OP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem Medicaid |
$7,134.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Humana KY Medicaid |
$7,134.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,207.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,277.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
15 SLV MD CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 SLV MD CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 SLV MD CONE 2 SPOU TALL SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 SLV MD CONE 2 SPOU TALL SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 SLV SM CONE 2 SPOU TALL SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 SLV SM CONE 2 SPOU TALL SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
15 STEM LNG REV POL +0 L
|
Facility
|
IP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
15 STEM LNG REV POL +0 L
|
Facility
|
OP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem Medicaid |
$7,779.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Humana KY Medicaid |
$7,779.19
|
| Rate for Payer: Kentucky WC Medicaid |
$7,858.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,935.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
15 STEM LNG REV POL +0 R
|
Facility
|
IP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
15 STEM LNG REV POL +0 R
|
Facility
|
OP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem Medicaid |
$7,779.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Humana KY Medicaid |
$7,779.19
|
| Rate for Payer: Kentucky WC Medicaid |
$7,858.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,935.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
15 STEM LNG REV POL +10 L
|
Facility
|
OP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem Medicaid |
$7,779.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Humana KY Medicaid |
$7,779.19
|
| Rate for Payer: Kentucky WC Medicaid |
$7,858.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,935.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
