|
STEM ACCOLADE II SZ 0 132 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 10 127 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 10 127 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 10 132 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 10 132 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 11 127 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 11 127 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 11 132 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 11 132 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 1 127 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 1 127 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 1 132 DEG
|
Facility
|
OP
|
$13,955.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,814.19 |
| Max. Negotiated Rate |
$13,397.13 |
| Rate for Payer: Aetna Commercial |
$10,745.61
|
| Rate for Payer: Anthem Medicaid |
$4,799.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,885.17
|
| Rate for Payer: Cash Price |
$6,977.67
|
| Rate for Payer: Cigna Commercial |
$11,582.93
|
| Rate for Payer: First Health Commercial |
$13,257.57
|
| Rate for Payer: Humana Commercial |
$11,862.04
|
| Rate for Payer: Humana KY Medicaid |
$4,799.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,848.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,443.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,299.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,186.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,895.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,280.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,791.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,814.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,326.16
|
| Rate for Payer: PHCS Commercial |
$13,397.13
|
| Rate for Payer: United Healthcare All Payer |
$12,280.70
|
|
|
STEM ACCOLADE II SZ 1 132 DEG
|
Facility
|
IP
|
$13,955.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,814.19 |
| Max. Negotiated Rate |
$13,397.13 |
| Rate for Payer: Aetna Commercial |
$10,745.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,885.17
|
| Rate for Payer: Cash Price |
$6,977.67
|
| Rate for Payer: Cigna Commercial |
$11,582.93
|
| Rate for Payer: First Health Commercial |
$13,257.57
|
| Rate for Payer: Humana Commercial |
$11,862.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,443.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,299.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,186.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,280.70
|
| Rate for Payer: Ohio Health Group HMO |
$10,466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,791.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,814.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,326.16
|
| Rate for Payer: PHCS Commercial |
$13,397.13
|
| Rate for Payer: United Healthcare All Payer |
$12,280.70
|
|
|
STEM ACCOLADE II SZ 2 127 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 2 127 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 2 132 DEG
|
Facility
|
OP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem Medicaid |
$4,762.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Humana KY Medicaid |
$4,762.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM ACCOLADE II SZ 2 132 DEG
|
Facility
|
IP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM ACCOLADE II SZ 3 127 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 3 127 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 3 132 DEG
|
Facility
|
IP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM ACCOLADE II SZ 3 132 DEG
|
Facility
|
OP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem Medicaid |
$4,762.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Humana KY Medicaid |
$4,762.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM ACCOLADE II SZ 4 127 DEG
|
Facility
|
IP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM ACCOLADE II SZ 4 127 DEG
|
Facility
|
OP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem Medicaid |
$4,762.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Humana KY Medicaid |
$4,762.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM ACCOLADE II SZ 4 132 DEG
|
Facility
|
OP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem Medicaid |
$4,762.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Humana KY Medicaid |
$4,762.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM ACCOLADE II SZ 4 132 DEG
|
Facility
|
IP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
