|
STEM MONO SLVD HO SZ20 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD HO SZ20 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ12 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ12 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ13 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ13 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ14 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ14 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ15 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ15 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ16 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ16 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ17 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ17 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ18 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ18 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ19 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ19 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ20 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ20 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ21 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ21 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ22 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ22 240MM
|
Facility
|
OP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem Medicaid |
$12,433.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Humana KY Medicaid |
$12,433.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12,559.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,682.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
|
STEM MONO SLVD SO SZ23 240MM
|
Facility
|
IP
|
$36,154.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,846.22 |
| Max. Negotiated Rate |
$34,707.90 |
| Rate for Payer: Aetna Commercial |
$27,838.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,200.17
|
| Rate for Payer: Cash Price |
$18,077.03
|
| Rate for Payer: Cigna Commercial |
$30,007.87
|
| Rate for Payer: First Health Commercial |
$34,346.36
|
| Rate for Payer: Humana Commercial |
$30,730.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,646.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,846.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,815.57
|
| Rate for Payer: Ohio Health Group HMO |
$27,115.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,923.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,454.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,946.30
|
| Rate for Payer: PHCS Commercial |
$34,707.90
|
| Rate for Payer: United Healthcare All Payer |
$31,815.57
|
|
