|
STEM ACCOLADE II SZ 3 127 DEG
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM ACCOLADE II SZ 3 132 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 3 132 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 4 127 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 4 127 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 4 132 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 4 132 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 5 127 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 5 127 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 5 132 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 5 132 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 6 127 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 6 127 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 6 132 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 6 132 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 7 127 DEG
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM ACCOLADE II SZ 7 127 DEG
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM ACCOLADE II SZ 7 132 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 7 132 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 8 127 DEG
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM ACCOLADE II SZ 8 127 DEG
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM ACCOLADE II SZ 8 132 DEG
|
Facility
|
OP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem Medicaid |
$4,851.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Humana KY Medicaid |
$4,851.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,900.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,948.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 8 132 DEG
|
Facility
|
IP
|
$14,106.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.98 |
| Max. Negotiated Rate |
$13,542.33 |
| Rate for Payer: Aetna Commercial |
$10,862.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,003.14
|
| Rate for Payer: Cash Price |
$7,053.30
|
| Rate for Payer: Cigna Commercial |
$11,708.47
|
| Rate for Payer: First Health Commercial |
$13,401.26
|
| Rate for Payer: Humana Commercial |
$11,990.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,567.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,410.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,413.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,579.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,285.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,272.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,733.55
|
| Rate for Payer: PHCS Commercial |
$13,542.33
|
| Rate for Payer: United Healthcare All Payer |
$12,413.80
|
|
|
STEM ACCOLADE II SZ 9 127 DEG
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
STEM ACCOLADE II SZ 9 127 DEG
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
