|
STEM INTEGR SI-PLUS W TI/HA 0
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 0
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 01
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 01
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 1
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 1
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 10
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 10
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 11
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 11
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 12
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 12
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 2
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 2
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 3
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 3
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 4
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 4
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 5
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 5
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 6
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 6
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 7
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 7
|
Facility
|
IP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
|
STEM INTEGR SI-PLUS W TI/HA 8
|
Facility
|
OP
|
$27,967.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.77 |
| Max. Negotiated Rate |
$26,848.76 |
| Rate for Payer: Aetna Commercial |
$21,534.94
|
| Rate for Payer: Anthem Medicaid |
$9,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,814.62
|
| Rate for Payer: Cash Price |
$13,983.73
|
| Rate for Payer: Cigna Commercial |
$23,212.99
|
| Rate for Payer: First Health Commercial |
$26,569.09
|
| Rate for Payer: Humana Commercial |
$23,772.34
|
| Rate for Payer: Humana KY Medicaid |
$9,618.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,639.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,390.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,810.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,611.36
|
| Rate for Payer: Ohio Health Group HMO |
$20,975.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,593.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.91
|
| Rate for Payer: PHCS Commercial |
$26,848.76
|
| Rate for Payer: United Healthcare All Payer |
$24,611.36
|
|
