|
EMP STEM 21 LNG REV POL +10 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 +20 L
|
Facility
|
OP
|
$29,036.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.68 |
| Max. Negotiated Rate |
$27,874.56 |
| Rate for Payer: Aetna Commercial |
$22,357.72
|
| Rate for Payer: Anthem Medicaid |
$9,985.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,648.08
|
| Rate for Payer: Cash Price |
$14,518.00
|
| Rate for Payer: Cigna Commercial |
$24,099.88
|
| Rate for Payer: First Health Commercial |
$27,584.20
|
| Rate for Payer: Humana Commercial |
$24,680.60
|
| Rate for Payer: Humana KY Medicaid |
$9,985.48
|
| Rate for Payer: Kentucky WC Medicaid |
$10,087.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,809.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,428.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,710.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,185.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,551.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,777.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,807.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,001.16
|
| Rate for Payer: PHCS Commercial |
$27,874.56
|
| Rate for Payer: United Healthcare All Payer |
$25,551.68
|
|
|
EMP STEM 21 LNG REV POL +20 L
|
Facility
|
IP
|
$29,036.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.68 |
| Max. Negotiated Rate |
$27,874.56 |
| Rate for Payer: Aetna Commercial |
$22,357.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,648.08
|
| Rate for Payer: Cash Price |
$14,518.00
|
| Rate for Payer: Cigna Commercial |
$24,099.88
|
| Rate for Payer: First Health Commercial |
$27,584.20
|
| Rate for Payer: Humana Commercial |
$24,680.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,809.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,428.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,710.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,551.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,777.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,807.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,001.16
|
| Rate for Payer: PHCS Commercial |
$27,874.56
|
| Rate for Payer: United Healthcare All Payer |
$25,551.68
|
|
|
EMP STEM 21 LNG REV POL +20 R
|
Facility
|
OP
|
$29,036.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.77 |
| Max. Negotiated Rate |
$27,875.26 |
| Rate for Payer: Aetna Commercial |
$22,358.28
|
| Rate for Payer: Anthem Medicaid |
$9,985.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,648.65
|
| Rate for Payer: Cash Price |
$14,518.36
|
| Rate for Payer: Cigna Commercial |
$24,100.49
|
| Rate for Payer: First Health Commercial |
$27,584.89
|
| Rate for Payer: Humana Commercial |
$24,681.22
|
| Rate for Payer: Humana KY Medicaid |
$9,985.73
|
| Rate for Payer: Kentucky WC Medicaid |
$10,087.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,810.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,429.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,711.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,186.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,552.32
|
| Rate for Payer: Ohio Health Group HMO |
$21,777.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,807.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,001.39
|
| Rate for Payer: PHCS Commercial |
$27,875.26
|
| Rate for Payer: United Healthcare All Payer |
$25,552.32
|
|
|
EMP STEM 21 LNG REV POL +20 R
|
Facility
|
IP
|
$29,036.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.77 |
| Max. Negotiated Rate |
$27,875.26 |
| Rate for Payer: Aetna Commercial |
$22,358.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,648.65
|
| Rate for Payer: Cash Price |
$14,518.36
|
| Rate for Payer: Cigna Commercial |
$24,100.49
|
| Rate for Payer: First Health Commercial |
$27,584.89
|
| Rate for Payer: Humana Commercial |
$24,681.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,810.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,429.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,711.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,552.32
|
| Rate for Payer: Ohio Health Group HMO |
$21,777.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,807.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,001.39
|
| Rate for Payer: PHCS Commercial |
$27,875.26
|
| Rate for Payer: United Healthcare All Payer |
$25,552.32
|
|
|
EMP STEM 21 SH REV POL +0
|
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 SH REV POL +0
|
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 SH REV POL +10
|
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 SH REV POL +10
|
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 23 LNG REV POL +0 L
|
Facility
|
IP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP STEM 23 LNG REV POL +0 L
|
Facility
|
OP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem Medicaid |
$4,030.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Humana KY Medicaid |
$4,030.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,071.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,111.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP STEM 23 LNG REV POL +0 R
|
Facility
|
IP
|
$22,816.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.11 |
| Max. Negotiated Rate |
$21,903.57 |
| Rate for Payer: Aetna Commercial |
$17,568.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,796.65
|
| Rate for Payer: Cash Price |
$11,408.11
|
| Rate for Payer: Cigna Commercial |
$18,937.46
|
| Rate for Payer: First Health Commercial |
$21,675.41
|
| Rate for Payer: Humana Commercial |
$19,393.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,838.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,844.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,078.27
|
| Rate for Payer: Ohio Health Group HMO |
$17,112.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,563.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,073.03
|
| Rate for Payer: PHCS Commercial |
$21,903.57
|
| Rate for Payer: United Healthcare All Payer |
$20,078.27
|
|
|
EMP STEM 23 LNG REV POL +0 R
|
Facility
|
OP
|
$22,816.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.11 |
| Max. Negotiated Rate |
$21,903.57 |
| Rate for Payer: Aetna Commercial |
$17,568.49
|
| Rate for Payer: Anthem Medicaid |
$7,846.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,796.65
|
| Rate for Payer: Cash Price |
$11,408.11
|
| Rate for Payer: Cigna Commercial |
$18,937.46
|
| Rate for Payer: First Health Commercial |
$21,675.41
|
| Rate for Payer: Humana Commercial |
$19,393.79
|
| Rate for Payer: Humana KY Medicaid |
$7,846.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,926.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,838.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,844.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,003.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,078.27
|
| Rate for Payer: Ohio Health Group HMO |
$17,112.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,563.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,073.03
|
| Rate for Payer: PHCS Commercial |
$21,903.57
|
| Rate for Payer: United Healthcare All Payer |
$20,078.27
|
|
|
EMP STEM 23 LNG REV POL +10 L
|
Facility
|
OP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem Medicaid |
$8,915.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Humana KY Medicaid |
$8,915.58
|
| Rate for Payer: Kentucky WC Medicaid |
$9,006.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,094.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 LNG REV POL +10 L
|
Facility
|
IP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 LNG REV POL +10 R
|
Facility
|
IP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 LNG REV POL +10 R
|
Facility
|
OP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem Medicaid |
$8,915.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Humana KY Medicaid |
$8,915.58
|
| Rate for Payer: Kentucky WC Medicaid |
$9,006.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,094.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 LNG REV POL +20 L
|
Facility
|
OP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem Medicaid |
$8,915.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Humana KY Medicaid |
$8,915.58
|
| Rate for Payer: Kentucky WC Medicaid |
$9,006.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,094.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 LNG REV POL +20 L
|
Facility
|
IP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 LNG REV POL +20 R
|
Facility
|
IP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 LNG REV POL +20 R
|
Facility
|
OP
|
$25,924.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.24 |
| Max. Negotiated Rate |
$24,887.92 |
| Rate for Payer: Aetna Commercial |
$19,962.19
|
| Rate for Payer: Anthem Medicaid |
$8,915.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,221.44
|
| Rate for Payer: Cash Price |
$12,962.46
|
| Rate for Payer: Cigna Commercial |
$21,517.68
|
| Rate for Payer: First Health Commercial |
$24,628.67
|
| Rate for Payer: Humana Commercial |
$22,036.18
|
| Rate for Payer: Humana KY Medicaid |
$8,915.58
|
| Rate for Payer: Kentucky WC Medicaid |
$9,006.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,258.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,132.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,777.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,094.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,813.93
|
| Rate for Payer: Ohio Health Group HMO |
$19,443.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,184.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,370.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,036.73
|
| Rate for Payer: PHCS Commercial |
$24,887.92
|
| Rate for Payer: United Healthcare All Payer |
$22,813.93
|
|
|
EMP STEM 23 SH REV POL +0
|
Facility
|
IP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP STEM 23 SH REV POL +0
|
Facility
|
OP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem Medicaid |
$4,030.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Humana KY Medicaid |
$4,030.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,071.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,111.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP STEM 23 SH REV POL +10
|
Facility
|
IP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP STEM 23 SH REV POL +10
|
Facility
|
OP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem Medicaid |
$4,030.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Humana KY Medicaid |
$4,030.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,071.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,111.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
