|
STEM S-ROM STD 14*09*130 36 NK
|
Facility
|
IP
|
$15,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.55 |
| Max. Negotiated Rate |
$15,312.38 |
| Rate for Payer: Aetna Commercial |
$12,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,441.31
|
| Rate for Payer: Cash Price |
$7,975.20
|
| Rate for Payer: Cigna Commercial |
$13,238.83
|
| Rate for Payer: First Health Commercial |
$15,152.88
|
| Rate for Payer: Humana Commercial |
$13,557.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,079.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,771.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,785.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,036.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,962.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,073.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,944.62
|
| Rate for Payer: PHCS Commercial |
$15,312.38
|
| Rate for Payer: United Healthcare All Payer |
$14,036.35
|
|
|
STEM S-ROM STD 14*09*130 36 NK
|
Facility
|
OP
|
$15,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.55 |
| Max. Negotiated Rate |
$15,312.38 |
| Rate for Payer: Aetna Commercial |
$12,281.81
|
| Rate for Payer: Anthem Medicaid |
$5,485.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,441.31
|
| Rate for Payer: Cash Price |
$7,975.20
|
| Rate for Payer: Cigna Commercial |
$13,238.83
|
| Rate for Payer: First Health Commercial |
$15,152.88
|
| Rate for Payer: Humana Commercial |
$13,557.84
|
| Rate for Payer: Humana KY Medicaid |
$5,485.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,541.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,079.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,771.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,785.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,595.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,036.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,962.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,073.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,944.62
|
| Rate for Payer: PHCS Commercial |
$15,312.38
|
| Rate for Payer: United Healthcare All Payer |
$14,036.35
|
|
|
STEM S-ROM STD 14*09*150 30 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 14*09*150 30 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 16*11*150 30 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 16*11*150 30 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 16*11*150 36 NK
|
Facility
|
IP
|
$15,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.55 |
| Max. Negotiated Rate |
$15,312.38 |
| Rate for Payer: Aetna Commercial |
$12,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,441.31
|
| Rate for Payer: Cash Price |
$7,975.20
|
| Rate for Payer: Cigna Commercial |
$13,238.83
|
| Rate for Payer: First Health Commercial |
$15,152.88
|
| Rate for Payer: Humana Commercial |
$13,557.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,079.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,771.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,785.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,036.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,962.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,073.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,944.62
|
| Rate for Payer: PHCS Commercial |
$15,312.38
|
| Rate for Payer: United Healthcare All Payer |
$14,036.35
|
|
|
STEM S-ROM STD 16*11*150 36 NK
|
Facility
|
OP
|
$15,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,073.55 |
| Max. Negotiated Rate |
$15,312.38 |
| Rate for Payer: Aetna Commercial |
$12,281.81
|
| Rate for Payer: Anthem Medicaid |
$5,485.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,441.31
|
| Rate for Payer: Cash Price |
$7,975.20
|
| Rate for Payer: Cigna Commercial |
$13,238.83
|
| Rate for Payer: First Health Commercial |
$15,152.88
|
| Rate for Payer: Humana Commercial |
$13,557.84
|
| Rate for Payer: Humana KY Medicaid |
$5,485.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,541.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,079.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,771.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,785.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,595.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,036.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,962.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,073.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,944.62
|
| Rate for Payer: PHCS Commercial |
$15,312.38
|
| Rate for Payer: United Healthcare All Payer |
$14,036.35
|
|
|
STEM S-ROM STD 18*13*160 30 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 18*13*160 30 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 18*13*160 36 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 18*13*160 36 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 18*13*160 42 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 18*13*160 42 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 20*15*165 36 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 20*15*165 36 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 20*15*165 42 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 20*15*165 42 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 22*17*165 36 NK
|
Facility
|
OP
|
$22,101.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,873.13 |
| Max. Negotiated Rate |
$21,216.96 |
| Rate for Payer: Aetna Commercial |
$17,017.77
|
| Rate for Payer: Anthem Medicaid |
$7,600.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,238.78
|
| Rate for Payer: Cash Price |
$11,050.50
|
| Rate for Payer: Cigna Commercial |
$18,343.83
|
| Rate for Payer: First Health Commercial |
$20,995.95
|
| Rate for Payer: Humana Commercial |
$18,785.85
|
| Rate for Payer: Humana KY Medicaid |
$7,600.53
|
| Rate for Payer: Kentucky WC Medicaid |
$7,677.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,122.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,310.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,630.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,753.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,448.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,575.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,873.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,851.31
|
| Rate for Payer: PHCS Commercial |
$21,216.96
|
| Rate for Payer: United Healthcare All Payer |
$19,448.88
|
|
|
STEM S-ROM STD 22*17*165 36 NK
|
Facility
|
IP
|
$22,101.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,873.13 |
| Max. Negotiated Rate |
$21,216.96 |
| Rate for Payer: Aetna Commercial |
$17,017.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,238.78
|
| Rate for Payer: Cash Price |
$11,050.50
|
| Rate for Payer: Cigna Commercial |
$18,343.83
|
| Rate for Payer: First Health Commercial |
$20,995.95
|
| Rate for Payer: Humana Commercial |
$18,785.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,122.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,310.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,630.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,448.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,575.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,873.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,851.31
|
| Rate for Payer: PHCS Commercial |
$21,216.96
|
| Rate for Payer: United Healthcare All Payer |
$19,448.88
|
|
|
STEM S-ROM STD 22*17*165 42 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 22*17*165 42 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 24*19*175 36 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 24*19*175 36 NK
|
Facility
|
IP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
|
STEM S-ROM STD 24*19*175 42 NK
|
Facility
|
OP
|
$16,051.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.75 |
| Max. Negotiated Rate |
$15,409.84 |
| Rate for Payer: Aetna Commercial |
$12,359.98
|
| Rate for Payer: Anthem Medicaid |
$5,520.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.50
|
| Rate for Payer: Cash Price |
$8,025.96
|
| Rate for Payer: Cigna Commercial |
$13,323.09
|
| Rate for Payer: First Health Commercial |
$15,249.32
|
| Rate for Payer: Humana Commercial |
$13,644.13
|
| Rate for Payer: Humana KY Medicaid |
$5,520.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,631.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,210.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,086.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,976.10
|
| Rate for Payer: PHCS Commercial |
$15,409.84
|
| Rate for Payer: United Healthcare All Payer |
$14,125.69
|
|
