|
STEM SEG STR VSS 12MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 13MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 13MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 14MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 14MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 15MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 15MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 16MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 16MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 17MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 17MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 18MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 18MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 19MMX130MM
|
Facility
|
OP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem Medicaid |
$6,346.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Humana KY Medicaid |
$6,346.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,473.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SEG STR VSS 19MMX130MM
|
Facility
|
IP
|
$18,453.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.00 |
| Max. Negotiated Rate |
$17,715.72 |
| Rate for Payer: Aetna Commercial |
$14,209.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,394.03
|
| Rate for Payer: Cash Price |
$9,226.94
|
| Rate for Payer: Cigna Commercial |
$15,316.72
|
| Rate for Payer: First Health Commercial |
$17,531.19
|
| Rate for Payer: Humana Commercial |
$15,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,132.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,618.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,239.41
|
| Rate for Payer: Ohio Health Group HMO |
$13,840.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,399.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.70
|
| Rate for Payer: PHCS Commercial |
$17,715.72
|
| Rate for Payer: United Healthcare All Payer |
$16,239.41
|
|
|
STEM SH TAPERED PC STD SZ 11
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPERED PC STD SZ 11
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 4
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 4
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 6
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 6
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 7
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 7
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 8
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STEM SH TAPER PC HO SZ 8
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
