|
STEM LNG GII 16MMX150MM
|
Facility
|
OP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Humana KY Medicaid |
$2,961.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 16MMX150MM
|
Facility
|
IP
|
$8,612.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.64 |
| Max. Negotiated Rate |
$8,268.12 |
| Rate for Payer: Aetna Commercial |
$6,631.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.84
|
| Rate for Payer: Cash Price |
$4,306.31
|
| Rate for Payer: Cigna Commercial |
$7,148.47
|
| Rate for Payer: First Health Commercial |
$8,181.99
|
| Rate for Payer: Humana Commercial |
$7,320.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,062.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,356.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,579.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.91
|
| Rate for Payer: PHCS Commercial |
$8,268.12
|
| Rate for Payer: United Healthcare All Payer |
$7,579.11
|
|
|
STEM LNG GII 18MMX100MM
|
Facility
|
OP
|
$8,611.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.50 |
| Max. Negotiated Rate |
$8,267.07 |
| Rate for Payer: Aetna Commercial |
$6,630.88
|
| Rate for Payer: Anthem Medicaid |
$2,961.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.99
|
| Rate for Payer: Cash Price |
$4,305.76
|
| Rate for Payer: Cigna Commercial |
$7,147.57
|
| Rate for Payer: First Health Commercial |
$8,180.95
|
| Rate for Payer: Humana Commercial |
$7,319.80
|
| Rate for Payer: Humana KY Medicaid |
$2,961.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,578.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.57
|
| Rate for Payer: PHCS Commercial |
$8,267.07
|
| Rate for Payer: United Healthcare All Payer |
$7,578.15
|
|
|
STEM LNG GII 18MMX100MM
|
Facility
|
IP
|
$8,611.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.50 |
| Max. Negotiated Rate |
$8,267.07 |
| Rate for Payer: Aetna Commercial |
$6,630.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.99
|
| Rate for Payer: Cash Price |
$4,305.76
|
| Rate for Payer: Cigna Commercial |
$7,147.57
|
| Rate for Payer: First Health Commercial |
$8,180.95
|
| Rate for Payer: Humana Commercial |
$7,319.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,578.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.57
|
| Rate for Payer: PHCS Commercial |
$8,267.07
|
| Rate for Payer: United Healthcare All Payer |
$7,578.15
|
|
|
STEM LNG GII 22MMX100MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM LNG GII 22MMX100MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM LNG GII 24MMX100MM
|
Facility
|
IP
|
$8,611.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.50 |
| Max. Negotiated Rate |
$8,267.07 |
| Rate for Payer: Aetna Commercial |
$6,630.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.99
|
| Rate for Payer: Cash Price |
$4,305.76
|
| Rate for Payer: Cigna Commercial |
$7,147.57
|
| Rate for Payer: First Health Commercial |
$8,180.95
|
| Rate for Payer: Humana Commercial |
$7,319.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,578.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.57
|
| Rate for Payer: PHCS Commercial |
$8,267.07
|
| Rate for Payer: United Healthcare All Payer |
$7,578.15
|
|
|
STEM LNG GII 24MMX100MM
|
Facility
|
OP
|
$8,611.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.50 |
| Max. Negotiated Rate |
$8,267.07 |
| Rate for Payer: Aetna Commercial |
$6,630.88
|
| Rate for Payer: Anthem Medicaid |
$2,961.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.99
|
| Rate for Payer: Cash Price |
$4,305.76
|
| Rate for Payer: Cigna Commercial |
$7,147.57
|
| Rate for Payer: First Health Commercial |
$8,180.95
|
| Rate for Payer: Humana Commercial |
$7,319.80
|
| Rate for Payer: Humana KY Medicaid |
$2,961.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,578.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.57
|
| Rate for Payer: PHCS Commercial |
$8,267.07
|
| Rate for Payer: United Healthcare All Payer |
$7,578.15
|
|
|
STEM LPS CEM 10*100MM STR
|
Facility
|
IP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM 10*100MM STR
|
Facility
|
OP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem Medicaid |
$7,823.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Humana KY Medicaid |
$7,823.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,980.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM 11*100MM STR
|
Facility
|
OP
|
$26,532.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,449.17 |
| Max. Negotiated Rate |
$25,470.82 |
| Rate for Payer: Aetna Commercial |
$20,429.72
|
| Rate for Payer: Anthem Medicaid |
$9,124.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,695.04
|
| Rate for Payer: Cash Price |
$13,266.05
|
| Rate for Payer: Cigna Commercial |
$22,021.64
|
| Rate for Payer: First Health Commercial |
$25,205.50
|
| Rate for Payer: Humana Commercial |
$22,552.28
|
| Rate for Payer: Humana KY Medicaid |
$9,124.39
|
| Rate for Payer: Kentucky WC Medicaid |
$9,217.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,756.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,580.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,959.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,307.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,348.25
|
| Rate for Payer: Ohio Health Group HMO |
$19,899.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,306.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,449.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,224.95
|
| Rate for Payer: PHCS Commercial |
$25,470.82
|
| Rate for Payer: United Healthcare All Payer |
$23,348.25
|
|
|
STEM LPS CEM 11*100MM STR
|
Facility
|
IP
|
$26,532.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,449.17 |
| Max. Negotiated Rate |
$25,470.82 |
| Rate for Payer: Aetna Commercial |
$20,429.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,695.04
|
| Rate for Payer: Cash Price |
$13,266.05
|
| Rate for Payer: Cigna Commercial |
$22,021.64
|
| Rate for Payer: First Health Commercial |
$25,205.50
|
| Rate for Payer: Humana Commercial |
$22,552.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,756.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,580.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,959.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,348.25
|
| Rate for Payer: Ohio Health Group HMO |
$19,899.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,306.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,449.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,224.95
|
| Rate for Payer: PHCS Commercial |
$25,470.82
|
| Rate for Payer: United Healthcare All Payer |
$23,348.25
|
|
|
STEM LPS CEM 12*100MM STR
|
Facility
|
OP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem Medicaid |
$7,823.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Humana KY Medicaid |
$7,823.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,980.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM 12*100MM STR
|
Facility
|
IP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM 12*125MM STR
|
Facility
|
IP
|
$27,619.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,590.57 |
| Max. Negotiated Rate |
$26,515.01 |
| Rate for Payer: Aetna Commercial |
$21,267.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,543.44
|
| Rate for Payer: Cash Price |
$13,809.90
|
| Rate for Payer: Cigna Commercial |
$22,924.43
|
| Rate for Payer: First Health Commercial |
$26,238.81
|
| Rate for Payer: Humana Commercial |
$23,476.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,648.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,383.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,285.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,305.42
|
| Rate for Payer: Ohio Health Group HMO |
$20,714.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,523.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,590.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,562.14
|
| Rate for Payer: PHCS Commercial |
$26,515.01
|
| Rate for Payer: United Healthcare All Payer |
$24,305.42
|
|
|
STEM LPS CEM 12*125MM STR
|
Facility
|
OP
|
$27,619.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,590.57 |
| Max. Negotiated Rate |
$26,515.01 |
| Rate for Payer: Aetna Commercial |
$21,267.25
|
| Rate for Payer: Anthem Medicaid |
$9,498.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,543.44
|
| Rate for Payer: Cash Price |
$13,809.90
|
| Rate for Payer: Cigna Commercial |
$22,924.43
|
| Rate for Payer: First Health Commercial |
$26,238.81
|
| Rate for Payer: Humana Commercial |
$23,476.83
|
| Rate for Payer: Humana KY Medicaid |
$9,498.45
|
| Rate for Payer: Kentucky WC Medicaid |
$9,595.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,648.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,383.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,285.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,689.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,305.42
|
| Rate for Payer: Ohio Health Group HMO |
$20,714.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,523.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,590.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,562.14
|
| Rate for Payer: PHCS Commercial |
$26,515.01
|
| Rate for Payer: United Healthcare All Payer |
$24,305.42
|
|
|
STEM LPS CEM 13*125MM STR
|
Facility
|
IP
|
$24,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,186.30 |
| Max. Negotiated Rate |
$23,529.60 |
| Rate for Payer: Aetna Commercial |
$18,872.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,117.80
|
| Rate for Payer: Cash Price |
$12,255.00
|
| Rate for Payer: Cigna Commercial |
$20,343.30
|
| Rate for Payer: First Health Commercial |
$23,284.50
|
| Rate for Payer: Humana Commercial |
$20,833.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,098.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,353.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,568.80
|
| Rate for Payer: Ohio Health Group HMO |
$18,382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,186.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,598.10
|
| Rate for Payer: PHCS Commercial |
$23,529.60
|
| Rate for Payer: United Healthcare All Payer |
$21,568.80
|
|
|
STEM LPS CEM 13*125MM STR
|
Facility
|
OP
|
$24,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,186.30 |
| Max. Negotiated Rate |
$23,529.60 |
| Rate for Payer: Aetna Commercial |
$18,872.70
|
| Rate for Payer: Anthem Medicaid |
$8,428.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,117.80
|
| Rate for Payer: Cash Price |
$12,255.00
|
| Rate for Payer: Cigna Commercial |
$20,343.30
|
| Rate for Payer: First Health Commercial |
$23,284.50
|
| Rate for Payer: Humana Commercial |
$20,833.50
|
| Rate for Payer: Humana KY Medicaid |
$8,428.99
|
| Rate for Payer: Kentucky WC Medicaid |
$8,514.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,098.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,353.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,598.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,568.80
|
| Rate for Payer: Ohio Health Group HMO |
$18,382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,186.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,598.10
|
| Rate for Payer: PHCS Commercial |
$23,529.60
|
| Rate for Payer: United Healthcare All Payer |
$21,568.80
|
|
|
STEM LPS CEM 14*125MM STR
|
Facility
|
OP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem Medicaid |
$7,823.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Humana KY Medicaid |
$7,823.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,980.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM 14*125MM STR
|
Facility
|
IP
|
$22,749.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.46 |
| Max. Negotiated Rate |
$21,839.69 |
| Rate for Payer: Aetna Commercial |
$17,517.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,744.75
|
| Rate for Payer: Cash Price |
$11,374.84
|
| Rate for Payer: Cigna Commercial |
$18,882.23
|
| Rate for Payer: First Health Commercial |
$21,612.20
|
| Rate for Payer: Humana Commercial |
$19,337.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,789.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,824.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,019.72
|
| Rate for Payer: Ohio Health Group HMO |
$17,062.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,549.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.40
|
| Rate for Payer: PHCS Commercial |
$21,839.69
|
| Rate for Payer: United Healthcare All Payer |
$20,019.72
|
|
|
STEM LPS CEM 15*125MM STR
|
Facility
|
OP
|
$25,378.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,299.25 |
| Max. Negotiated Rate |
$24,363.72 |
| Rate for Payer: Aetna Commercial |
$19,541.74
|
| Rate for Payer: Anthem Medicaid |
$8,727.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,795.53
|
| Rate for Payer: Cash Price |
$12,689.44
|
| Rate for Payer: Cigna Commercial |
$21,064.47
|
| Rate for Payer: First Health Commercial |
$24,109.94
|
| Rate for Payer: Humana Commercial |
$21,572.05
|
| Rate for Payer: Humana KY Medicaid |
$8,727.80
|
| Rate for Payer: Kentucky WC Medicaid |
$8,816.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,810.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,729.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,613.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,902.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,333.41
|
| Rate for Payer: Ohio Health Group HMO |
$19,034.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,075.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,299.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,867.45
|
| Rate for Payer: PHCS Commercial |
$24,363.72
|
| Rate for Payer: United Healthcare All Payer |
$22,333.41
|
|
|
STEM LPS CEM 15*125MM STR
|
Facility
|
IP
|
$25,378.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,299.25 |
| Max. Negotiated Rate |
$24,363.72 |
| Rate for Payer: Aetna Commercial |
$19,541.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,795.53
|
| Rate for Payer: Cash Price |
$12,689.44
|
| Rate for Payer: Cigna Commercial |
$21,064.47
|
| Rate for Payer: First Health Commercial |
$24,109.94
|
| Rate for Payer: Humana Commercial |
$21,572.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,810.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,729.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,613.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,333.41
|
| Rate for Payer: Ohio Health Group HMO |
$19,034.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,075.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,299.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,867.45
|
| Rate for Payer: PHCS Commercial |
$24,363.72
|
| Rate for Payer: United Healthcare All Payer |
$22,333.41
|
|
|
STEM LPS CEM 16*125MM STR
|
Facility
|
OP
|
$25,378.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,299.25 |
| Max. Negotiated Rate |
$24,363.72 |
| Rate for Payer: Aetna Commercial |
$19,541.74
|
| Rate for Payer: Anthem Medicaid |
$8,727.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,795.53
|
| Rate for Payer: Cash Price |
$12,689.44
|
| Rate for Payer: Cigna Commercial |
$21,064.47
|
| Rate for Payer: First Health Commercial |
$24,109.94
|
| Rate for Payer: Humana Commercial |
$21,572.05
|
| Rate for Payer: Humana KY Medicaid |
$8,727.80
|
| Rate for Payer: Kentucky WC Medicaid |
$8,816.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,810.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,729.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,613.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,902.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,333.41
|
| Rate for Payer: Ohio Health Group HMO |
$19,034.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,075.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,299.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,867.45
|
| Rate for Payer: PHCS Commercial |
$24,363.72
|
| Rate for Payer: United Healthcare All Payer |
$22,333.41
|
|
|
STEM LPS CEM 16*125MM STR
|
Facility
|
IP
|
$25,378.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,299.25 |
| Max. Negotiated Rate |
$24,363.72 |
| Rate for Payer: Aetna Commercial |
$19,541.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,795.53
|
| Rate for Payer: Cash Price |
$12,689.44
|
| Rate for Payer: Cigna Commercial |
$21,064.47
|
| Rate for Payer: First Health Commercial |
$24,109.94
|
| Rate for Payer: Humana Commercial |
$21,572.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,810.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,729.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,613.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,333.41
|
| Rate for Payer: Ohio Health Group HMO |
$19,034.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,075.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,299.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,867.45
|
| Rate for Payer: PHCS Commercial |
$24,363.72
|
| Rate for Payer: United Healthcare All Payer |
$22,333.41
|
|
|
STEM LPS CEM 17*125MM STR
|
Facility
|
OP
|
$26,532.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,449.17 |
| Max. Negotiated Rate |
$25,470.82 |
| Rate for Payer: Aetna Commercial |
$20,429.72
|
| Rate for Payer: Anthem Medicaid |
$9,124.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,695.04
|
| Rate for Payer: Cash Price |
$13,266.05
|
| Rate for Payer: Cigna Commercial |
$22,021.64
|
| Rate for Payer: First Health Commercial |
$25,205.50
|
| Rate for Payer: Humana Commercial |
$22,552.28
|
| Rate for Payer: Humana KY Medicaid |
$9,124.39
|
| Rate for Payer: Kentucky WC Medicaid |
$9,217.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,756.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,580.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,959.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,307.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,348.25
|
| Rate for Payer: Ohio Health Group HMO |
$19,899.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,306.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,449.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,224.95
|
| Rate for Payer: PHCS Commercial |
$25,470.82
|
| Rate for Payer: United Healthcare All Payer |
$23,348.25
|
|
