|
STEM CMTED SMTH OSS 150BW-12
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150BW-13
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150BW-13
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150BW-14
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150BW-14
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-11
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-11
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-13
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-13
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-15
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-15
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-9
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 150ST-9
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 90ST-11
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 90ST-11
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 90ST-12
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 90ST-12
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 90ST-13
|
Facility
|
OP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem Medicaid |
$4,222.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Humana KY Medicaid |
$4,222.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,265.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM CMTED SMTH OSS 90ST-13
|
Facility
|
IP
|
$12,278.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.59 |
| Max. Negotiated Rate |
$11,787.49 |
| Rate for Payer: Aetna Commercial |
$9,454.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,577.34
|
| Rate for Payer: Cash Price |
$6,139.32
|
| Rate for Payer: Cigna Commercial |
$10,191.27
|
| Rate for Payer: First Health Commercial |
$11,664.71
|
| Rate for Payer: Humana Commercial |
$10,436.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,068.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,061.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,805.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,208.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,822.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,682.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,472.26
|
| Rate for Payer: PHCS Commercial |
$11,787.49
|
| Rate for Payer: United Healthcare All Payer |
$10,805.20
|
|
|
STEM COCR HUM COFLD 2 10M*145M
|
Facility
|
IP
|
$9,745.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,923.56 |
| Max. Negotiated Rate |
$9,355.39 |
| Rate for Payer: Aetna Commercial |
$7,503.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,601.26
|
| Rate for Payer: Cash Price |
$4,872.60
|
| Rate for Payer: Cigna Commercial |
$8,088.52
|
| Rate for Payer: First Health Commercial |
$9,257.94
|
| Rate for Payer: Humana Commercial |
$8,283.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,991.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,191.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,923.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,575.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,308.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,796.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,478.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,724.19
|
| Rate for Payer: PHCS Commercial |
$9,355.39
|
| Rate for Payer: United Healthcare All Payer |
$8,575.78
|
|
|
STEM COCR HUM COFLD 2 10M*145M
|
Facility
|
OP
|
$9,745.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,923.56 |
| Max. Negotiated Rate |
$9,355.39 |
| Rate for Payer: Aetna Commercial |
$7,503.80
|
| Rate for Payer: Anthem Medicaid |
$3,351.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,601.26
|
| Rate for Payer: Cash Price |
$4,872.60
|
| Rate for Payer: Cigna Commercial |
$8,088.52
|
| Rate for Payer: First Health Commercial |
$9,257.94
|
| Rate for Payer: Humana Commercial |
$8,283.42
|
| Rate for Payer: Humana KY Medicaid |
$3,351.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,385.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,991.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,191.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,923.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,418.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,575.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,308.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,796.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,478.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,724.19
|
| Rate for Payer: PHCS Commercial |
$9,355.39
|
| Rate for Payer: United Healthcare All Payer |
$8,575.78
|
|
|
STEM COCR HUM COFLD 2 8MM*145M
|
Facility
|
OP
|
$9,745.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,923.56 |
| Max. Negotiated Rate |
$9,355.39 |
| Rate for Payer: Aetna Commercial |
$7,503.80
|
| Rate for Payer: Anthem Medicaid |
$3,351.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,601.26
|
| Rate for Payer: Cash Price |
$4,872.60
|
| Rate for Payer: Cigna Commercial |
$8,088.52
|
| Rate for Payer: First Health Commercial |
$9,257.94
|
| Rate for Payer: Humana Commercial |
$8,283.42
|
| Rate for Payer: Humana KY Medicaid |
$3,351.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,385.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,991.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,191.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,923.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,418.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,575.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,308.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,796.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,478.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,724.19
|
| Rate for Payer: PHCS Commercial |
$9,355.39
|
| Rate for Payer: United Healthcare All Payer |
$8,575.78
|
|
|
STEM COCR HUM COFLD 2 8MM*145M
|
Facility
|
IP
|
$9,745.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,923.56 |
| Max. Negotiated Rate |
$9,355.39 |
| Rate for Payer: Aetna Commercial |
$7,503.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,601.26
|
| Rate for Payer: Cash Price |
$4,872.60
|
| Rate for Payer: Cigna Commercial |
$8,088.52
|
| Rate for Payer: First Health Commercial |
$9,257.94
|
| Rate for Payer: Humana Commercial |
$8,283.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,991.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,191.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,923.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,575.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,308.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,796.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,478.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,724.19
|
| Rate for Payer: PHCS Commercial |
$9,355.39
|
| Rate for Payer: United Healthcare All Payer |
$8,575.78
|
|
|
STEM COLLAR 32 18*120MM
|
Facility
|
OP
|
$23,341.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,002.38 |
| Max. Negotiated Rate |
$22,407.60 |
| Rate for Payer: Aetna Commercial |
$17,972.76
|
| Rate for Payer: Anthem Medicaid |
$8,027.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,206.17
|
| Rate for Payer: Cash Price |
$11,670.62
|
| Rate for Payer: Cigna Commercial |
$19,373.24
|
| Rate for Payer: First Health Commercial |
$22,174.19
|
| Rate for Payer: Humana Commercial |
$19,840.06
|
| Rate for Payer: Humana KY Medicaid |
$8,027.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,108.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,139.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,002.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,188.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,540.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,505.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,673.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,306.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,105.46
|
| Rate for Payer: PHCS Commercial |
$22,407.60
|
| Rate for Payer: United Healthcare All Payer |
$20,540.30
|
|
|
STEM COLLAR 32 18*120MM
|
Facility
|
IP
|
$23,341.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,002.38 |
| Max. Negotiated Rate |
$22,407.60 |
| Rate for Payer: Aetna Commercial |
$17,972.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,206.17
|
| Rate for Payer: Cash Price |
$11,670.62
|
| Rate for Payer: Cigna Commercial |
$19,373.24
|
| Rate for Payer: First Health Commercial |
$22,174.19
|
| Rate for Payer: Humana Commercial |
$19,840.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,139.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,002.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,540.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,505.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,673.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,306.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,105.46
|
| Rate for Payer: PHCS Commercial |
$22,407.60
|
| Rate for Payer: United Healthcare All Payer |
$20,540.30
|
|
