|
EMP STEM 13 LNG REV POL +20 L
|
Facility
|
IP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 13 LNG REV POL +20 L
|
Facility
|
OP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem Medicaid |
$8,568.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Humana KY Medicaid |
$8,568.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,656.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,740.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 13 LNG REV POL +20 R
|
Facility
|
IP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 13 LNG REV POL +20 R
|
Facility
|
OP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem Medicaid |
$8,568.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Humana KY Medicaid |
$8,568.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,656.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,740.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 15 LNG TEV POL +20 L
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 15 LNG TEV POL +20 L
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 15 LNG TEV POL +20 R
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 15 LNG TEV POL +20 R
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 17 LNG REV POL +20 L
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 17 LNG REV POL +20 L
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 17 LNG REV POL +20 R
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 17 LNG REV POL +20 R
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 19 LNG REV POL +20 L
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 19 LNG REV POL +20 L
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 19 LNG REV POL +20 R
|
Facility
|
IP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 19 LNG REV POL +20 R
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
EMP STEM 19 SH REV POL +20
|
Facility
|
IP
|
$16,700.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.01 |
| Max. Negotiated Rate |
$16,032.10 |
| Rate for Payer: Aetna Commercial |
$12,859.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,026.08
|
| Rate for Payer: Cash Price |
$8,350.05
|
| Rate for Payer: Cigna Commercial |
$13,861.08
|
| Rate for Payer: First Health Commercial |
$15,865.10
|
| Rate for Payer: Humana Commercial |
$14,195.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,694.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,324.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,696.09
|
| Rate for Payer: Ohio Health Group HMO |
$12,525.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,171.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,177.03
|
| Rate for Payer: PHCS Commercial |
$16,032.10
|
| Rate for Payer: United Healthcare All Payer |
$14,696.09
|
|
|
EMP STEM 19 SH REV POL +20
|
Facility
|
OP
|
$16,700.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.01 |
| Max. Negotiated Rate |
$16,032.10 |
| Rate for Payer: Aetna Commercial |
$12,859.08
|
| Rate for Payer: Anthem Medicaid |
$5,743.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,026.08
|
| Rate for Payer: Cash Price |
$8,350.05
|
| Rate for Payer: Cigna Commercial |
$13,861.08
|
| Rate for Payer: First Health Commercial |
$15,865.10
|
| Rate for Payer: Humana Commercial |
$14,195.08
|
| Rate for Payer: Humana KY Medicaid |
$5,743.16
|
| Rate for Payer: Kentucky WC Medicaid |
$5,801.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,694.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,324.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,858.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,696.09
|
| Rate for Payer: Ohio Health Group HMO |
$12,525.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,171.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,177.03
|
| Rate for Payer: PHCS Commercial |
$16,032.10
|
| Rate for Payer: United Healthcare All Payer |
$14,696.09
|
|
|
EMP STEM 21 LNG REV POL +0 L
|
Facility
|
IP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP STEM 21 LNG REV POL +0 L
|
Facility
|
OP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem Medicaid |
$7,184.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Humana KY Medicaid |
$7,184.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP STEM 21 LNG REV POL +0 R
|
Facility
|
IP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP STEM 21 LNG REV POL +0 R
|
Facility
|
OP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem Medicaid |
$7,184.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Humana KY Medicaid |
$7,184.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP STEM 21 LNG REV POL +10 L
|
Facility
|
OP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem Medicaid |
$7,184.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Humana KY Medicaid |
$7,184.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP STEM 21 LNG REV POL +10 L
|
Facility
|
IP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP STEM 21 LNG REV POL +10 R
|
Facility
|
OP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem Medicaid |
$7,184.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Humana KY Medicaid |
$7,184.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
