|
EMP STEM 11 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
|
|
|
EMP STEM 11 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
|
|
|
EMP STEM 11 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
|
|
|
EMP STEM 11 SH REV POL +10
|
Facility
|
IP
|
$23,191.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,957.32 |
| Max. Negotiated Rate |
$22,263.42 |
| Rate for Payer: Aetna Commercial |
$17,857.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,089.03
|
| Rate for Payer: Cash Price |
$11,595.53
|
| Rate for Payer: Cigna Commercial |
$19,248.58
|
| Rate for Payer: First Health Commercial |
$22,031.51
|
| Rate for Payer: Humana Commercial |
$19,712.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,016.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,115.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,957.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,408.13
|
| Rate for Payer: Ohio Health Group HMO |
$17,393.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,552.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,176.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,001.83
|
| Rate for Payer: PHCS Commercial |
$22,263.42
|
| Rate for Payer: United Healthcare All Payer |
$20,408.13
|
|
|
EMP STEM 11 SH REV POL +10
|
Facility
|
OP
|
$23,191.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,957.32 |
| Max. Negotiated Rate |
$22,263.42 |
| Rate for Payer: Aetna Commercial |
$17,857.12
|
| Rate for Payer: Anthem Medicaid |
$7,975.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,089.03
|
| Rate for Payer: Cash Price |
$11,595.53
|
| Rate for Payer: Cigna Commercial |
$19,248.58
|
| Rate for Payer: First Health Commercial |
$22,031.51
|
| Rate for Payer: Humana Commercial |
$19,712.40
|
| Rate for Payer: Humana KY Medicaid |
$7,975.41
|
| Rate for Payer: Kentucky WC Medicaid |
$8,056.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,016.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,115.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,957.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,135.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,408.13
|
| Rate for Payer: Ohio Health Group HMO |
$17,393.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,552.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,176.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,001.83
|
| Rate for Payer: PHCS Commercial |
$22,263.42
|
| Rate for Payer: United Healthcare All Payer |
$20,408.13
|
|
|
EMP STEM 13 LNG REV POL +20 L
|
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
|
|
|
EMP STEM 13 LNG REV POL +20 L
|
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
|
|
|
EMP STEM 13 LNG REV POL +20 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
|
|
|
EMP STEM 13 LNG REV POL +20 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
|
|
|
EMP STEM 15 LNG TEV POL +20 L
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 15 LNG TEV POL +20 L
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 15 LNG TEV POL +20 R
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 15 LNG TEV POL +20 R
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 17 LNG REV POL +20 L
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 17 LNG REV POL +20 L
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 17 LNG REV POL +20 R
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 17 LNG REV POL +20 R
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 19 LNG REV POL +20 L
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 19 LNG REV POL +20 L
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 19 LNG REV POL +20 R
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 19 LNG REV POL +20 R
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
EMP STEM 19 SH REV POL +20
|
Facility
|
IP
|
$17,247.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,174.20 |
| Max. Negotiated Rate |
$16,557.43 |
| Rate for Payer: Aetna Commercial |
$13,280.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,452.91
|
| Rate for Payer: Cash Price |
$8,623.66
|
| Rate for Payer: Cigna Commercial |
$14,315.28
|
| Rate for Payer: First Health Commercial |
$16,384.95
|
| Rate for Payer: Humana Commercial |
$14,660.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,142.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,728.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,174.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,177.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,935.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,797.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,005.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,900.65
|
| Rate for Payer: PHCS Commercial |
$16,557.43
|
| Rate for Payer: United Healthcare All Payer |
$15,177.64
|
|
|
EMP STEM 19 SH REV POL +20
|
Facility
|
OP
|
$17,247.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,174.20 |
| Max. Negotiated Rate |
$16,557.43 |
| Rate for Payer: Aetna Commercial |
$13,280.44
|
| Rate for Payer: Anthem Medicaid |
$5,931.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,452.91
|
| Rate for Payer: Cash Price |
$8,623.66
|
| Rate for Payer: Cigna Commercial |
$14,315.28
|
| Rate for Payer: First Health Commercial |
$16,384.95
|
| Rate for Payer: Humana Commercial |
$14,660.22
|
| Rate for Payer: Humana KY Medicaid |
$5,931.35
|
| Rate for Payer: Kentucky WC Medicaid |
$5,991.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,142.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,728.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,174.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,050.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,177.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,935.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,797.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,005.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,900.65
|
| Rate for Payer: PHCS Commercial |
$16,557.43
|
| Rate for Payer: United Healthcare All Payer |
$15,177.64
|
|
|
EMP STEM 21 LNG REV POL +0 L
|
Facility
|
IP
|
$21,533.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.07 |
| Max. Negotiated Rate |
$20,672.22 |
| Rate for Payer: Aetna Commercial |
$16,580.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.18
|
| Rate for Payer: Cash Price |
$10,766.78
|
| Rate for Payer: Cigna Commercial |
$17,872.85
|
| Rate for Payer: First Health Commercial |
$20,456.88
|
| Rate for Payer: Humana Commercial |
$18,303.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.53
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,226.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.16
|
| Rate for Payer: PHCS Commercial |
$20,672.22
|
| Rate for Payer: United Healthcare All Payer |
$18,949.53
|
|
|
EMP STEM 21 LNG REV POL +0 L
|
Facility
|
OP
|
$21,533.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.07 |
| Max. Negotiated Rate |
$20,672.22 |
| Rate for Payer: Aetna Commercial |
$16,580.84
|
| Rate for Payer: Anthem Medicaid |
$7,405.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.18
|
| Rate for Payer: Cash Price |
$10,766.78
|
| Rate for Payer: Cigna Commercial |
$17,872.85
|
| Rate for Payer: First Health Commercial |
$20,456.88
|
| Rate for Payer: Humana Commercial |
$18,303.53
|
| Rate for Payer: Humana KY Medicaid |
$7,405.39
|
| Rate for Payer: Kentucky WC Medicaid |
$7,480.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,553.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.53
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,226.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.16
|
| Rate for Payer: PHCS Commercial |
$20,672.22
|
| Rate for Payer: United Healthcare All Payer |
$18,949.53
|
|
