|
STEM INTEGR SI-PLUS W TI/HA 12
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 12
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 2
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 2
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 3
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 3
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 4
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 4
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 5
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 5
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 6
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 6
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 7
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 7
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 8
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 8
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 9
|
Facility
|
IP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM INTEGR SI-PLUS W TI/HA 9
|
Facility
|
OP
|
$28,802.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,640.66 |
| Max. Negotiated Rate |
$27,650.10 |
| Rate for Payer: Aetna Commercial |
$22,177.69
|
| Rate for Payer: Anthem Medicaid |
$9,905.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,465.71
|
| Rate for Payer: Cash Price |
$14,401.09
|
| Rate for Payer: Cigna Commercial |
$23,905.82
|
| Rate for Payer: First Health Commercial |
$27,362.08
|
| Rate for Payer: Humana Commercial |
$24,481.86
|
| Rate for Payer: Humana KY Medicaid |
$9,905.07
|
| Rate for Payer: Kentucky WC Medicaid |
$10,005.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,617.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,256.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,640.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,103.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,345.93
|
| Rate for Payer: Ohio Health Group HMO |
$21,601.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,041.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,057.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,873.51
|
| Rate for Payer: PHCS Commercial |
$27,650.10
|
| Rate for Payer: United Healthcare All Payer |
$25,345.93
|
|
|
STEM LAT TI/HA NON-CEM 1
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM LAT TI/HA NON-CEM 1
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM LAT TI/HA NON-CEM 10
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM LAT TI/HA NON-CEM 10
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM LAT TI/HA NON-CEM 2
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM LAT TI/HA NON-CEM 2
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM LAT TI/HA NON-CEM 3
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
