|
EMP STEM 21 LNG REV POL +0 R
|
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
|
|
|
EMP STEM 21 LNG REV POL +0 R
|
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 +10 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 +10 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
|
|
|
EMP STEM 21 LNG REV POL +10 R
|
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
|
|
|
EMP STEM 21 LNG REV POL +10 R
|
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 +20 L
|
Facility
|
IP
|
$29,900.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,970.00 |
| Max. Negotiated Rate |
$28,704.00 |
| Rate for Payer: Aetna Commercial |
$23,023.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,322.00
|
| Rate for Payer: Cash Price |
$14,950.00
|
| Rate for Payer: Cigna Commercial |
$24,817.00
|
| Rate for Payer: First Health Commercial |
$28,405.00
|
| Rate for Payer: Humana Commercial |
$25,415.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,518.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,066.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,970.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,013.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,631.00
|
| Rate for Payer: PHCS Commercial |
$28,704.00
|
| Rate for Payer: United Healthcare All Payer |
$26,312.00
|
|
|
EMP STEM 21 LNG REV POL +20 L
|
Facility
|
OP
|
$29,900.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,970.00 |
| Max. Negotiated Rate |
$28,704.00 |
| Rate for Payer: Aetna Commercial |
$23,023.00
|
| Rate for Payer: Anthem Medicaid |
$10,282.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,322.00
|
| Rate for Payer: Cash Price |
$14,950.00
|
| Rate for Payer: Cigna Commercial |
$24,817.00
|
| Rate for Payer: First Health Commercial |
$28,405.00
|
| Rate for Payer: Humana Commercial |
$25,415.00
|
| Rate for Payer: Humana KY Medicaid |
$10,282.61
|
| Rate for Payer: Kentucky WC Medicaid |
$10,387.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,518.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,066.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,970.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,488.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,013.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,631.00
|
| Rate for Payer: PHCS Commercial |
$28,704.00
|
| Rate for Payer: United Healthcare All Payer |
$26,312.00
|
|
|
EMP STEM 21 LNG REV POL +20 R
|
Facility
|
IP
|
$29,900.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,970.23 |
| Max. Negotiated Rate |
$28,704.72 |
| Rate for Payer: Aetna Commercial |
$23,023.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,322.58
|
| Rate for Payer: Cash Price |
$14,950.38
|
| Rate for Payer: Cigna Commercial |
$24,817.62
|
| Rate for Payer: First Health Commercial |
$28,405.71
|
| Rate for Payer: Humana Commercial |
$25,415.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,518.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,066.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,970.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,312.66
|
| Rate for Payer: Ohio Health Group HMO |
$22,425.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,920.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,013.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,631.52
|
| Rate for Payer: PHCS Commercial |
$28,704.72
|
| Rate for Payer: United Healthcare All Payer |
$26,312.66
|
|
|
EMP STEM 21 LNG REV POL +20 R
|
Facility
|
OP
|
$29,900.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,970.23 |
| Max. Negotiated Rate |
$28,704.72 |
| Rate for Payer: Aetna Commercial |
$23,023.58
|
| Rate for Payer: Anthem Medicaid |
$10,282.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,322.58
|
| Rate for Payer: Cash Price |
$14,950.38
|
| Rate for Payer: Cigna Commercial |
$24,817.62
|
| Rate for Payer: First Health Commercial |
$28,405.71
|
| Rate for Payer: Humana Commercial |
$25,415.64
|
| Rate for Payer: Humana KY Medicaid |
$10,282.87
|
| Rate for Payer: Kentucky WC Medicaid |
$10,387.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,518.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,066.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,970.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,489.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,312.66
|
| Rate for Payer: Ohio Health Group HMO |
$22,425.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,920.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,013.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,631.52
|
| Rate for Payer: PHCS Commercial |
$28,704.72
|
| Rate for Payer: United Healthcare All Payer |
$26,312.66
|
|
|
EMP STEM 21 SH REV POL +0
|
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 SH REV POL +0
|
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
|
|
|
EMP STEM 21 SH REV POL +10
|
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 SH REV POL +10
|
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
|
|
|
EMP STEM 23 LNG REV POL +0 L
|
Facility
|
IP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
|
EMP STEM 23 LNG REV POL +0 L
|
Facility
|
OP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem Medicaid |
$4,115.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Humana KY Medicaid |
$4,115.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,157.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,197.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
|
EMP STEM 23 LNG REV POL +0 R
|
Facility
|
OP
|
$23,509.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,052.94 |
| Max. Negotiated Rate |
$22,569.42 |
| Rate for Payer: Aetna Commercial |
$18,102.55
|
| Rate for Payer: Anthem Medicaid |
$8,085.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,337.65
|
| Rate for Payer: Cash Price |
$11,754.91
|
| Rate for Payer: Cigna Commercial |
$19,513.14
|
| Rate for Payer: First Health Commercial |
$22,334.32
|
| Rate for Payer: Humana Commercial |
$19,983.34
|
| Rate for Payer: Humana KY Medicaid |
$8,085.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8,167.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,278.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,350.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,052.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,247.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,688.63
|
| Rate for Payer: Ohio Health Group HMO |
$17,632.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,807.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,453.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,221.77
|
| Rate for Payer: PHCS Commercial |
$22,569.42
|
| Rate for Payer: United Healthcare All Payer |
$20,688.63
|
|
|
EMP STEM 23 LNG REV POL +0 R
|
Facility
|
IP
|
$23,509.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,052.94 |
| Max. Negotiated Rate |
$22,569.42 |
| Rate for Payer: Aetna Commercial |
$18,102.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,337.65
|
| Rate for Payer: Cash Price |
$11,754.91
|
| Rate for Payer: Cigna Commercial |
$19,513.14
|
| Rate for Payer: First Health Commercial |
$22,334.32
|
| Rate for Payer: Humana Commercial |
$19,983.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,278.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,350.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,052.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,688.63
|
| Rate for Payer: Ohio Health Group HMO |
$17,632.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,807.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,453.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,221.77
|
| Rate for Payer: PHCS Commercial |
$22,569.42
|
| Rate for Payer: United Healthcare All Payer |
$20,688.63
|
|
|
EMP STEM 23 LNG REV POL +10 L
|
Facility
|
IP
|
$26,703.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,011.11 |
| Max. Negotiated Rate |
$25,635.54 |
| Rate for Payer: Aetna Commercial |
$20,561.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,828.88
|
| Rate for Payer: Cash Price |
$13,351.84
|
| Rate for Payer: Cigna Commercial |
$22,164.06
|
| Rate for Payer: First Health Commercial |
$25,368.51
|
| Rate for Payer: Humana Commercial |
$22,698.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,897.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,707.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,011.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,499.25
|
| Rate for Payer: Ohio Health Group HMO |
$20,027.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,362.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,232.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,425.55
|
| Rate for Payer: PHCS Commercial |
$25,635.54
|
| Rate for Payer: United Healthcare All Payer |
$23,499.25
|
|
|
EMP STEM 23 LNG REV POL +10 L
|
Facility
|
OP
|
$26,703.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,011.11 |
| Max. Negotiated Rate |
$25,635.54 |
| Rate for Payer: Aetna Commercial |
$20,561.84
|
| Rate for Payer: Anthem Medicaid |
$9,183.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,828.88
|
| Rate for Payer: Cash Price |
$13,351.84
|
| Rate for Payer: Cigna Commercial |
$22,164.06
|
| Rate for Payer: First Health Commercial |
$25,368.51
|
| Rate for Payer: Humana Commercial |
$22,698.14
|
| Rate for Payer: Humana KY Medicaid |
$9,183.40
|
| Rate for Payer: Kentucky WC Medicaid |
$9,276.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,897.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,707.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,011.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,367.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,499.25
|
| Rate for Payer: Ohio Health Group HMO |
$20,027.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,362.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,232.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,425.55
|
| Rate for Payer: PHCS Commercial |
$25,635.54
|
| Rate for Payer: United Healthcare All Payer |
$23,499.25
|
|
|
EMP STEM 23 LNG REV POL +10 R
|
Facility
|
IP
|
$26,703.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,011.11 |
| Max. Negotiated Rate |
$25,635.54 |
| Rate for Payer: Aetna Commercial |
$20,561.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,828.88
|
| Rate for Payer: Cash Price |
$13,351.84
|
| Rate for Payer: Cigna Commercial |
$22,164.06
|
| Rate for Payer: First Health Commercial |
$25,368.51
|
| Rate for Payer: Humana Commercial |
$22,698.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,897.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,707.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,011.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,499.25
|
| Rate for Payer: Ohio Health Group HMO |
$20,027.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,362.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,232.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,425.55
|
| Rate for Payer: PHCS Commercial |
$25,635.54
|
| Rate for Payer: United Healthcare All Payer |
$23,499.25
|
|
|
EMP STEM 23 LNG REV POL +10 R
|
Facility
|
OP
|
$26,703.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,011.11 |
| Max. Negotiated Rate |
$25,635.54 |
| Rate for Payer: Aetna Commercial |
$20,561.84
|
| Rate for Payer: Anthem Medicaid |
$9,183.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,828.88
|
| Rate for Payer: Cash Price |
$13,351.84
|
| Rate for Payer: Cigna Commercial |
$22,164.06
|
| Rate for Payer: First Health Commercial |
$25,368.51
|
| Rate for Payer: Humana Commercial |
$22,698.14
|
| Rate for Payer: Humana KY Medicaid |
$9,183.40
|
| Rate for Payer: Kentucky WC Medicaid |
$9,276.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,897.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,707.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,011.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,367.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,499.25
|
| Rate for Payer: Ohio Health Group HMO |
$20,027.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,362.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,232.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,425.55
|
| Rate for Payer: PHCS Commercial |
$25,635.54
|
| Rate for Payer: United Healthcare All Payer |
$23,499.25
|
|
|
EMP STEM 23 LNG REV POL +20 L
|
Facility
|
IP
|
$26,703.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,011.11 |
| Max. Negotiated Rate |
$25,635.54 |
| Rate for Payer: Aetna Commercial |
$20,561.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,828.88
|
| Rate for Payer: Cash Price |
$13,351.84
|
| Rate for Payer: Cigna Commercial |
$22,164.06
|
| Rate for Payer: First Health Commercial |
$25,368.51
|
| Rate for Payer: Humana Commercial |
$22,698.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,897.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,707.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,011.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,499.25
|
| Rate for Payer: Ohio Health Group HMO |
$20,027.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,362.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,232.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,425.55
|
| Rate for Payer: PHCS Commercial |
$25,635.54
|
| Rate for Payer: United Healthcare All Payer |
$23,499.25
|
|
|
EMP STEM 23 LNG REV POL +20 L
|
Facility
|
OP
|
$26,703.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,011.11 |
| Max. Negotiated Rate |
$25,635.54 |
| Rate for Payer: Aetna Commercial |
$20,561.84
|
| Rate for Payer: Anthem Medicaid |
$9,183.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,828.88
|
| Rate for Payer: Cash Price |
$13,351.84
|
| Rate for Payer: Cigna Commercial |
$22,164.06
|
| Rate for Payer: First Health Commercial |
$25,368.51
|
| Rate for Payer: Humana Commercial |
$22,698.14
|
| Rate for Payer: Humana KY Medicaid |
$9,183.40
|
| Rate for Payer: Kentucky WC Medicaid |
$9,276.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,897.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,707.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,011.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,367.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,499.25
|
| Rate for Payer: Ohio Health Group HMO |
$20,027.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,362.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,232.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,425.55
|
| Rate for Payer: PHCS Commercial |
$25,635.54
|
| Rate for Payer: United Healthcare All Payer |
$23,499.25
|
|
|
EMP STEM 23 LNG REV POL +20 R
|
Facility
|
OP
|
$26,703.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,011.11 |
| Max. Negotiated Rate |
$25,635.54 |
| Rate for Payer: Aetna Commercial |
$20,561.84
|
| Rate for Payer: Anthem Medicaid |
$9,183.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,828.88
|
| Rate for Payer: Cash Price |
$13,351.84
|
| Rate for Payer: Cigna Commercial |
$22,164.06
|
| Rate for Payer: First Health Commercial |
$25,368.51
|
| Rate for Payer: Humana Commercial |
$22,698.14
|
| Rate for Payer: Humana KY Medicaid |
$9,183.40
|
| Rate for Payer: Kentucky WC Medicaid |
$9,276.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,897.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,707.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,011.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,367.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,499.25
|
| Rate for Payer: Ohio Health Group HMO |
$20,027.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,362.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,232.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,425.55
|
| Rate for Payer: PHCS Commercial |
$25,635.54
|
| Rate for Payer: United Healthcare All Payer |
$23,499.25
|
|
