|
STEM MONO SLVD HO SZ15 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ15 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ16 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ16 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ17 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ17 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ18 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ18 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ19 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ19 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ20 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ20 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ12 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ12 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ13 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ13 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ14 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ14 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ15 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ15 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ16 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ16 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ17 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ17 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD SO SZ18 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
