|
STEM ACCOLADE II SZ 5 127 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 5 127 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 5 132 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 5 132 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 6 127 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 6 127 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 6 132 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 6 132 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 7 127 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 7 127 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 7 132 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 7 132 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 8 127 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 8 127 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 8 132 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 8 132 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 9 127 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 9 127 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 9 132 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 9 132 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 ACTIS DUOFIX 12/14 TPR SZ
|
Facility
|
OP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$4,084.67
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$4,084.67
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,126.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
STEM ACTIS DUOFIX 12/14 TPR SZ
|
Facility
|
IP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
STEM APEX HUMERAL 10 MINI
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
STEM APEX HUMERAL 10 MINI
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
STEM APEX HUMERAL 11 MINI
|
Facility
|
IP
|
$13,762.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,789.15 |
| Max. Negotiated Rate |
$13,212.22 |
| Rate for Payer: Aetna Commercial |
$10,597.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,734.93
|
| Rate for Payer: Cash Price |
$6,881.36
|
| Rate for Payer: Cigna Commercial |
$11,423.07
|
| Rate for Payer: First Health Commercial |
$13,074.59
|
| Rate for Payer: Humana Commercial |
$11,698.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,156.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,752.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,789.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,266.45
|
| Rate for Payer: PHCS Commercial |
$13,212.22
|
| Rate for Payer: United Healthcare All Payer |
$12,111.20
|
|
