|
STEM CMTED SMTH OSS 150ST-13
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150ST-13
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150ST-15
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150ST-15
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150ST-9
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150ST-9
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 90ST-11
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 90ST-11
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 90ST-12
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 90ST-12
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 90ST-13
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 90ST-13
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM COCR HUM COFLD 2 10M*145M
|
Facility
|
IP
|
$9,545.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.88 |
| Max. Negotiated Rate |
$9,163.39 |
| Rate for Payer: Aetna Commercial |
$7,349.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,445.26
|
| Rate for Payer: Cash Price |
$4,772.60
|
| Rate for Payer: Cigna Commercial |
$7,922.52
|
| Rate for Payer: First Health Commercial |
$9,067.94
|
| Rate for Payer: Humana Commercial |
$8,113.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,044.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,399.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,158.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,959.01
|
| Rate for Payer: PHCS Commercial |
$9,163.39
|
| Rate for Payer: United Healthcare All Payer |
$8,399.78
|
|
|
STEM COCR HUM COFLD 2 10M*145M
|
Facility
|
OP
|
$9,545.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.88 |
| Max. Negotiated Rate |
$9,163.39 |
| Rate for Payer: Aetna Commercial |
$7,349.80
|
| Rate for Payer: Anthem Medicaid |
$3,282.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,445.26
|
| Rate for Payer: Cash Price |
$4,772.60
|
| Rate for Payer: Cigna Commercial |
$7,922.52
|
| Rate for Payer: First Health Commercial |
$9,067.94
|
| Rate for Payer: Humana Commercial |
$8,113.42
|
| Rate for Payer: Humana KY Medicaid |
$3,282.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,316.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,044.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,348.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,399.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,158.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,959.01
|
| Rate for Payer: PHCS Commercial |
$9,163.39
|
| Rate for Payer: United Healthcare All Payer |
$8,399.78
|
|
|
STEM COCR HUM COFLD 2 8MM*145M
|
Facility
|
IP
|
$9,545.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.88 |
| Max. Negotiated Rate |
$9,163.39 |
| Rate for Payer: Aetna Commercial |
$7,349.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,445.26
|
| Rate for Payer: Cash Price |
$4,772.60
|
| Rate for Payer: Cigna Commercial |
$7,922.52
|
| Rate for Payer: First Health Commercial |
$9,067.94
|
| Rate for Payer: Humana Commercial |
$8,113.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,044.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,399.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,158.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,959.01
|
| Rate for Payer: PHCS Commercial |
$9,163.39
|
| Rate for Payer: United Healthcare All Payer |
$8,399.78
|
|
|
STEM COCR HUM COFLD 2 8MM*145M
|
Facility
|
OP
|
$9,545.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.88 |
| Max. Negotiated Rate |
$9,163.39 |
| Rate for Payer: Aetna Commercial |
$7,349.80
|
| Rate for Payer: Anthem Medicaid |
$3,282.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,445.26
|
| Rate for Payer: Cash Price |
$4,772.60
|
| Rate for Payer: Cigna Commercial |
$7,922.52
|
| Rate for Payer: First Health Commercial |
$9,067.94
|
| Rate for Payer: Humana Commercial |
$8,113.42
|
| Rate for Payer: Humana KY Medicaid |
$3,282.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,316.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,044.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,348.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,399.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,158.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,959.01
|
| Rate for Payer: PHCS Commercial |
$9,163.39
|
| Rate for Payer: United Healthcare All Payer |
$8,399.78
|
|
|
STEM COLLAR 32 18*120MM
|
Facility
|
IP
|
$22,652.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.78 |
| Max. Negotiated Rate |
$21,746.06 |
| Rate for Payer: Aetna Commercial |
$17,442.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,668.68
|
| Rate for Payer: Cash Price |
$11,326.08
|
| Rate for Payer: Cigna Commercial |
$18,801.28
|
| Rate for Payer: First Health Commercial |
$21,519.54
|
| Rate for Payer: Humana Commercial |
$19,254.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,574.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,795.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,933.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,989.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,530.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,944.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,022.17
|
| Rate for Payer: PHCS Commercial |
$21,746.06
|
| Rate for Payer: United Healthcare All Payer |
$19,933.89
|
|
|
STEM COLLAR 32 18*120MM
|
Facility
|
OP
|
$22,652.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.78 |
| Max. Negotiated Rate |
$21,746.06 |
| Rate for Payer: Aetna Commercial |
$17,442.16
|
| Rate for Payer: Anthem Medicaid |
$7,790.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,668.68
|
| Rate for Payer: Cash Price |
$11,326.08
|
| Rate for Payer: Cigna Commercial |
$18,801.28
|
| Rate for Payer: First Health Commercial |
$21,519.54
|
| Rate for Payer: Humana Commercial |
$19,254.33
|
| Rate for Payer: Humana KY Medicaid |
$7,790.07
|
| Rate for Payer: Kentucky WC Medicaid |
$7,869.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,574.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,795.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,946.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,933.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,989.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,530.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,944.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,022.17
|
| Rate for Payer: PHCS Commercial |
$21,746.06
|
| Rate for Payer: United Healthcare All Payer |
$19,933.89
|
|
|
STEM DIAPH ADAPTER OSS 1CM
|
Facility
|
OP
|
$40,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,244.68 |
| Max. Negotiated Rate |
$38,729.95 |
| Rate for Payer: Aetna Commercial |
$31,064.65
|
| Rate for Payer: Anthem Medicaid |
$13,874.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,468.09
|
| Rate for Payer: Cash Price |
$20,171.85
|
| Rate for Payer: Cigna Commercial |
$33,485.27
|
| Rate for Payer: First Health Commercial |
$38,326.52
|
| Rate for Payer: Humana Commercial |
$34,292.14
|
| Rate for Payer: Humana KY Medicaid |
$13,874.20
|
| Rate for Payer: Kentucky WC Medicaid |
$14,015.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,081.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,773.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,103.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,152.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,502.46
|
| Rate for Payer: Ohio Health Group HMO |
$30,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,068.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,244.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,506.55
|
| Rate for Payer: PHCS Commercial |
$38,729.95
|
| Rate for Payer: United Healthcare All Payer |
$35,502.46
|
|
|
STEM DIAPH ADAPTER OSS 1CM
|
Facility
|
IP
|
$40,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,244.68 |
| Max. Negotiated Rate |
$38,729.95 |
| Rate for Payer: Aetna Commercial |
$31,064.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,468.09
|
| Rate for Payer: Cash Price |
$20,171.85
|
| Rate for Payer: Cigna Commercial |
$33,485.27
|
| Rate for Payer: First Health Commercial |
$38,326.52
|
| Rate for Payer: Humana Commercial |
$34,292.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,081.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,773.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,103.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,502.46
|
| Rate for Payer: Ohio Health Group HMO |
$30,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,068.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,244.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,506.55
|
| Rate for Payer: PHCS Commercial |
$38,729.95
|
| Rate for Payer: United Healthcare All Payer |
$35,502.46
|
|
|
STEM DISTAL CENT 11MM
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.02 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: Anthem Medicaid |
$637.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.12
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna Commercial |
$1,538.82
|
| Rate for Payer: First Health Commercial |
$1,761.30
|
| Rate for Payer: Humana Commercial |
$1,575.90
|
| Rate for Payer: Humana KY Medicaid |
$637.59
|
| Rate for Payer: Kentucky WC Medicaid |
$644.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.74
|
| Rate for Payer: PHCS Commercial |
$1,779.84
|
| Rate for Payer: United Healthcare All Payer |
$1,631.52
|
|
|
STEM DISTAL CENT 11MM
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.02 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.12
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna Commercial |
$1,538.82
|
| Rate for Payer: First Health Commercial |
$1,761.30
|
| Rate for Payer: Humana Commercial |
$1,575.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.74
|
| Rate for Payer: PHCS Commercial |
$1,779.84
|
| Rate for Payer: United Healthcare All Payer |
$1,631.52
|
|
|
STEM ECHO BIFL PROX STD 10*130
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
STEM ECHO BIFL PROX STD 10*130
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
STEM ECHO BIFL PROX STD 11*135
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
