|
STEM SI-PLUS STAN NON-CEM 9
|
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 9
|
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 SL-PLUS MIA LATERAL SZ 0
|
Facility
|
IP
|
$24,444.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.76 |
| Max. Negotiated Rate |
$23,466.53 |
| Rate for Payer: Aetna Commercial |
$18,822.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,066.55
|
| Rate for Payer: Cash Price |
$12,222.15
|
| Rate for Payer: Cigna Commercial |
$20,288.77
|
| Rate for Payer: First Health Commercial |
$23,222.08
|
| Rate for Payer: Humana Commercial |
$20,777.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,044.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,039.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,333.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,510.98
|
| Rate for Payer: Ohio Health Group HMO |
$18,333.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,888.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,577.73
|
| Rate for Payer: PHCS Commercial |
$23,466.53
|
| Rate for Payer: United Healthcare All Payer |
$21,510.98
|
|
|
STEM SL-PLUS MIA LATERAL SZ 0
|
Facility
|
OP
|
$24,444.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.76 |
| Max. Negotiated Rate |
$23,466.53 |
| Rate for Payer: Aetna Commercial |
$18,822.11
|
| Rate for Payer: Anthem Medicaid |
$8,406.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,066.55
|
| Rate for Payer: Cash Price |
$12,222.15
|
| Rate for Payer: Cigna Commercial |
$20,288.77
|
| Rate for Payer: First Health Commercial |
$23,222.08
|
| Rate for Payer: Humana Commercial |
$20,777.66
|
| Rate for Payer: Humana KY Medicaid |
$8,406.39
|
| Rate for Payer: Kentucky WC Medicaid |
$8,491.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,044.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,039.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,333.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,575.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,510.98
|
| Rate for Payer: Ohio Health Group HMO |
$18,333.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,888.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,577.73
|
| Rate for Payer: PHCS Commercial |
$23,466.53
|
| Rate for Payer: United Healthcare All Payer |
$21,510.98
|
|
|
STEM SL-PLUS MIA LATERAL SZ 2
|
Facility
|
OP
|
$20,107.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,613.96 |
| Max. Negotiated Rate |
$19,303.08 |
| Rate for Payer: Aetna Commercial |
$15,482.67
|
| Rate for Payer: Anthem Medicaid |
$6,914.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,683.75
|
| Rate for Payer: Cash Price |
$10,053.68
|
| Rate for Payer: Cigna Commercial |
$16,689.12
|
| Rate for Payer: First Health Commercial |
$19,102.00
|
| Rate for Payer: Humana Commercial |
$17,091.26
|
| Rate for Payer: Humana KY Medicaid |
$6,914.92
|
| Rate for Payer: Kentucky WC Medicaid |
$6,985.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,488.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,839.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,032.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,053.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,694.49
|
| Rate for Payer: Ohio Health Group HMO |
$15,080.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,021.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,613.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,233.28
|
| Rate for Payer: PHCS Commercial |
$19,303.08
|
| Rate for Payer: United Healthcare All Payer |
$17,694.49
|
|
|
STEM SL-PLUS MIA LATERAL SZ 2
|
Facility
|
IP
|
$20,107.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,613.96 |
| Max. Negotiated Rate |
$19,303.08 |
| Rate for Payer: Aetna Commercial |
$15,482.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,683.75
|
| Rate for Payer: Cash Price |
$10,053.68
|
| Rate for Payer: Cigna Commercial |
$16,689.12
|
| Rate for Payer: First Health Commercial |
$19,102.00
|
| Rate for Payer: Humana Commercial |
$17,091.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,488.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,839.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,032.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,694.49
|
| Rate for Payer: Ohio Health Group HMO |
$15,080.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,021.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,613.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,233.28
|
| Rate for Payer: PHCS Commercial |
$19,303.08
|
| Rate for Payer: United Healthcare All Payer |
$17,694.49
|
|
|
STEM SL-PLUS MIA LATERAL SZ 4
|
Facility
|
IP
|
$30,992.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.01 |
| Max. Negotiated Rate |
$29,752.70 |
| Rate for Payer: Aetna Commercial |
$23,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,174.07
|
| Rate for Payer: Cash Price |
$15,496.20
|
| Rate for Payer: Cigna Commercial |
$25,723.69
|
| Rate for Payer: First Health Commercial |
$29,442.78
|
| Rate for Payer: Humana Commercial |
$26,343.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,872.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,273.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,244.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,198.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,029.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,607.64
|
| Rate for Payer: PHCS Commercial |
$29,752.70
|
| Rate for Payer: United Healthcare All Payer |
$27,273.31
|
|
|
STEM SL-PLUS MIA LATERAL SZ 4
|
Facility
|
OP
|
$30,992.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.01 |
| Max. Negotiated Rate |
$29,752.70 |
| Rate for Payer: Aetna Commercial |
$23,864.15
|
| Rate for Payer: Anthem Medicaid |
$10,658.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,174.07
|
| Rate for Payer: Cash Price |
$15,496.20
|
| Rate for Payer: Cigna Commercial |
$25,723.69
|
| Rate for Payer: First Health Commercial |
$29,442.78
|
| Rate for Payer: Humana Commercial |
$26,343.54
|
| Rate for Payer: Humana KY Medicaid |
$10,658.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,766.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,872.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,297.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,872.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,273.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,244.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,198.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,029.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,607.64
|
| Rate for Payer: PHCS Commercial |
$29,752.70
|
| Rate for Payer: United Healthcare All Payer |
$27,273.31
|
|
|
STEM SL-PLUS MIA LATERAL SZ 5
|
Facility
|
IP
|
$24,444.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.76 |
| Max. Negotiated Rate |
$23,466.53 |
| Rate for Payer: Aetna Commercial |
$18,822.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,066.55
|
| Rate for Payer: Cash Price |
$12,222.15
|
| Rate for Payer: Cigna Commercial |
$20,288.77
|
| Rate for Payer: First Health Commercial |
$23,222.08
|
| Rate for Payer: Humana Commercial |
$20,777.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,044.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,039.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,333.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,510.98
|
| Rate for Payer: Ohio Health Group HMO |
$18,333.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,888.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,577.73
|
| Rate for Payer: PHCS Commercial |
$23,466.53
|
| Rate for Payer: United Healthcare All Payer |
$21,510.98
|
|
|
STEM SL-PLUS MIA LATERAL SZ 5
|
Facility
|
OP
|
$24,444.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.76 |
| Max. Negotiated Rate |
$23,466.53 |
| Rate for Payer: Aetna Commercial |
$18,822.11
|
| Rate for Payer: Anthem Medicaid |
$8,406.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,066.55
|
| Rate for Payer: Cash Price |
$12,222.15
|
| Rate for Payer: Cigna Commercial |
$20,288.77
|
| Rate for Payer: First Health Commercial |
$23,222.08
|
| Rate for Payer: Humana Commercial |
$20,777.66
|
| Rate for Payer: Humana KY Medicaid |
$8,406.39
|
| Rate for Payer: Kentucky WC Medicaid |
$8,491.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,044.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,039.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,333.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,575.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,510.98
|
| Rate for Payer: Ohio Health Group HMO |
$18,333.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,888.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,577.73
|
| Rate for Payer: PHCS Commercial |
$23,466.53
|
| Rate for Payer: United Healthcare All Payer |
$21,510.98
|
|
|
STEM SL-PLUS MIA LATERAL SZ 6
|
Facility
|
IP
|
$30,992.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.01 |
| Max. Negotiated Rate |
$29,752.70 |
| Rate for Payer: Aetna Commercial |
$23,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,174.07
|
| Rate for Payer: Cash Price |
$15,496.20
|
| Rate for Payer: Cigna Commercial |
$25,723.69
|
| Rate for Payer: First Health Commercial |
$29,442.78
|
| Rate for Payer: Humana Commercial |
$26,343.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,872.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,273.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,244.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,198.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,029.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,607.64
|
| Rate for Payer: PHCS Commercial |
$29,752.70
|
| Rate for Payer: United Healthcare All Payer |
$27,273.31
|
|
|
STEM SL-PLUS MIA LATERAL SZ 6
|
Facility
|
OP
|
$30,992.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.01 |
| Max. Negotiated Rate |
$29,752.70 |
| Rate for Payer: Aetna Commercial |
$23,864.15
|
| Rate for Payer: Anthem Medicaid |
$10,658.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,174.07
|
| Rate for Payer: Cash Price |
$15,496.20
|
| Rate for Payer: Cigna Commercial |
$25,723.69
|
| Rate for Payer: First Health Commercial |
$29,442.78
|
| Rate for Payer: Humana Commercial |
$26,343.54
|
| Rate for Payer: Humana KY Medicaid |
$10,658.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,766.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,872.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,297.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,872.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,273.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,244.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,198.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,029.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,607.64
|
| Rate for Payer: PHCS Commercial |
$29,752.70
|
| Rate for Payer: United Healthcare All Payer |
$27,273.31
|
|
|
STEM SL-PLUS MIA LATERAL SZ 7
|
Facility
|
OP
|
$30,992.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.01 |
| Max. Negotiated Rate |
$29,752.70 |
| Rate for Payer: Aetna Commercial |
$23,864.15
|
| Rate for Payer: Anthem Medicaid |
$10,658.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,174.07
|
| Rate for Payer: Cash Price |
$15,496.20
|
| Rate for Payer: Cigna Commercial |
$25,723.69
|
| Rate for Payer: First Health Commercial |
$29,442.78
|
| Rate for Payer: Humana Commercial |
$26,343.54
|
| Rate for Payer: Humana KY Medicaid |
$10,658.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,766.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,872.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,297.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,872.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,273.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,244.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,198.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,029.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,607.64
|
| Rate for Payer: PHCS Commercial |
$29,752.70
|
| Rate for Payer: United Healthcare All Payer |
$27,273.31
|
|
|
STEM SL-PLUS MIA LATERAL SZ 7
|
Facility
|
IP
|
$30,992.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.01 |
| Max. Negotiated Rate |
$29,752.70 |
| Rate for Payer: Aetna Commercial |
$23,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,174.07
|
| Rate for Payer: Cash Price |
$15,496.20
|
| Rate for Payer: Cigna Commercial |
$25,723.69
|
| Rate for Payer: First Health Commercial |
$29,442.78
|
| Rate for Payer: Humana Commercial |
$26,343.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,872.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,273.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,244.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,198.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,029.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,607.64
|
| Rate for Payer: PHCS Commercial |
$29,752.70
|
| Rate for Payer: United Healthcare All Payer |
$27,273.31
|
|
|
STEM SMF STIKTITE HO SZ 0
|
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 SMF STIKTITE HO SZ 0
|
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 SMF STIKTITE HO SZ -1
|
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 SMF STIKTITE HO SZ -1
|
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 SMF STIKTITE SZ 0
|
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 SMF STIKTITE SZ 0
|
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 SMF STIKTITE SZ -1
|
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 SMF STIKTITE SZ -1
|
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 SMOOTH EXT BIOMET 10X40
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM SMOOTH EXT BIOMET 10X40
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM SMOOTH EXT BIOMET 10X80
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
