|
STEM MONO SLVD SO 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 SO 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 SO 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 SO 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 SO 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 SZ21 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 SZ21 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 SZ22 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 SZ22 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 SZ23 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 SZ23 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 SZ24 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 SZ24 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 SZ25 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 SZ25 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 SZ26 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 SZ26 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 SZ27 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 SZ27 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 SLVLS HO SZ12 190MM
|
Facility
|
OP
|
$33,802.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,394.28 |
| Max. Negotiated Rate |
$32,450.08 |
| Rate for Payer: Aetna Commercial |
$26,027.67
|
| Rate for Payer: Anthem Medicaid |
$11,624.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,365.69
|
| Rate for Payer: Cash Price |
$16,901.08
|
| Rate for Payer: Cigna Commercial |
$28,055.80
|
| Rate for Payer: First Health Commercial |
$32,112.06
|
| Rate for Payer: Humana Commercial |
$28,731.84
|
| Rate for Payer: Humana KY Medicaid |
$11,624.57
|
| Rate for Payer: Kentucky WC Medicaid |
$11,742.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,717.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,946.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,140.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,857.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,745.91
|
| Rate for Payer: Ohio Health Group HMO |
$25,351.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,760.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,478.67
|
| Rate for Payer: PHCS Commercial |
$32,450.08
|
| Rate for Payer: United Healthcare All Payer |
$29,745.91
|
|
|
STEM MONO SLVLS HO SZ12 190MM
|
Facility
|
IP
|
$33,802.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,394.28 |
| Max. Negotiated Rate |
$32,450.08 |
| Rate for Payer: Aetna Commercial |
$26,027.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,365.69
|
| Rate for Payer: Cash Price |
$16,901.08
|
| Rate for Payer: Cigna Commercial |
$28,055.80
|
| Rate for Payer: First Health Commercial |
$32,112.06
|
| Rate for Payer: Humana Commercial |
$28,731.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,717.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,946.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,140.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,745.91
|
| Rate for Payer: Ohio Health Group HMO |
$25,351.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,760.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,478.67
|
| Rate for Payer: PHCS Commercial |
$32,450.08
|
| Rate for Payer: United Healthcare All Payer |
$29,745.91
|
|
|
STEM MONO SLVLS HO SZ12 240MM
|
Facility
|
IP
|
$36,642.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,763.47 |
| Max. Negotiated Rate |
$35,176.37 |
| Rate for Payer: Aetna Commercial |
$28,214.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,580.80
|
| Rate for Payer: Cash Price |
$18,321.03
|
| Rate for Payer: Cigna Commercial |
$30,412.90
|
| Rate for Payer: First Health Commercial |
$34,809.95
|
| Rate for Payer: Humana Commercial |
$31,145.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,046.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,041.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,992.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,481.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,328.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,763.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,359.04
|
| Rate for Payer: PHCS Commercial |
$35,176.37
|
| Rate for Payer: United Healthcare All Payer |
$32,245.00
|
|
|
STEM MONO SLVLS HO SZ12 240MM
|
Facility
|
OP
|
$36,642.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,763.47 |
| Max. Negotiated Rate |
$35,176.37 |
| Rate for Payer: Aetna Commercial |
$28,214.38
|
| Rate for Payer: Anthem Medicaid |
$12,601.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,580.80
|
| Rate for Payer: Cash Price |
$18,321.03
|
| Rate for Payer: Cigna Commercial |
$30,412.90
|
| Rate for Payer: First Health Commercial |
$34,809.95
|
| Rate for Payer: Humana Commercial |
$31,145.74
|
| Rate for Payer: Humana KY Medicaid |
$12,601.20
|
| Rate for Payer: Kentucky WC Medicaid |
$12,729.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,046.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,041.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,992.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,854.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,481.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,328.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,763.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,359.04
|
| Rate for Payer: PHCS Commercial |
$35,176.37
|
| Rate for Payer: United Healthcare All Payer |
$32,245.00
|
|
|
STEM MONO SLVLS HO SZ12 300MM
|
Facility
|
OP
|
$38,379.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,989.31 |
| Max. Negotiated Rate |
$36,844.10 |
| Rate for Payer: Aetna Commercial |
$29,552.04
|
| Rate for Payer: Anthem Medicaid |
$13,198.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,935.83
|
| Rate for Payer: Cash Price |
$19,189.63
|
| Rate for Payer: Cigna Commercial |
$31,854.79
|
| Rate for Payer: First Health Commercial |
$36,460.31
|
| Rate for Payer: Humana Commercial |
$32,622.38
|
| Rate for Payer: Humana KY Medicaid |
$13,198.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13,332.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,471.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,323.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,513.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,463.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,773.76
|
| Rate for Payer: Ohio Health Group HMO |
$28,784.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,675.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,989.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,897.57
|
| Rate for Payer: PHCS Commercial |
$36,844.10
|
| Rate for Payer: United Healthcare All Payer |
$33,773.76
|
|
|
STEM MONO SLVLS HO SZ12 300MM
|
Facility
|
IP
|
$38,379.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,989.31 |
| Max. Negotiated Rate |
$36,844.10 |
| Rate for Payer: Aetna Commercial |
$29,552.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,935.83
|
| Rate for Payer: Cash Price |
$19,189.63
|
| Rate for Payer: Cigna Commercial |
$31,854.79
|
| Rate for Payer: First Health Commercial |
$36,460.31
|
| Rate for Payer: Humana Commercial |
$32,622.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,471.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,323.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,513.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,773.76
|
| Rate for Payer: Ohio Health Group HMO |
$28,784.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,675.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,989.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,897.57
|
| Rate for Payer: PHCS Commercial |
$36,844.10
|
| Rate for Payer: United Healthcare All Payer |
$33,773.76
|
|
