|
STEM SI-PLUS STAN NON-CEM 0
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 01
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 01
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 1
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 1
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 10
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 10
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 11
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 11
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 12
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 12
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 2
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 2
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 3
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 3
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 4
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 4
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 5
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 5
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 6
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 6
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 7
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 7
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 8
|
Facility
|
IP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
|
STEM SI-PLUS STAN NON-CEM 8
|
Facility
|
OP
|
$23,542.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,060.56 |
| Max. Negotiated Rate |
$22,601.04 |
| Rate for Payer: Aetna Commercial |
$18,127.92
|
| Rate for Payer: Anthem Medicaid |
$8,096.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,363.34
|
| Rate for Payer: Cash Price |
$11,771.38
|
| Rate for Payer: Cigna Commercial |
$19,540.48
|
| Rate for Payer: First Health Commercial |
$22,365.61
|
| Rate for Payer: Humana Commercial |
$20,011.34
|
| Rate for Payer: Humana KY Medicaid |
$8,096.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,178.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,305.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,374.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,258.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,717.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,657.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,708.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,060.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,298.25
|
| Rate for Payer: PHCS Commercial |
$22,601.04
|
| Rate for Payer: United Healthcare All Payer |
$20,717.62
|
|
