|
STEM POR PROX TIB OSS 16.5*150
|
Facility
|
IP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
|
STEM POR PROX TIB OSS 16.5*150
|
Facility
|
OP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem Medicaid |
$5,394.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Humana KY Medicaid |
$5,394.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,449.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,502.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
|
STEM PROX TIB POR OSS 10.5X150
|
Facility
|
OP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem Medicaid |
$5,394.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Humana KY Medicaid |
$5,394.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,449.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,502.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
|
STEM PROX TIB POR OSS 10.5X150
|
Facility
|
IP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
|
STEM REDAPT SLVLS HOSZ12 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ12 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ13 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ13 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ14 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ14 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ15 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ15 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ16 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ16 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ17 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ17 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ18 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ18 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ19 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ19 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ20 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ20 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ21 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ21 300MM
|
Facility
|
OP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem Medicaid |
$13,017.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Humana KY Medicaid |
$13,017.78
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,278.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
|
STEM REDAPT SLVLS HOSZ22 300MM
|
Facility
|
IP
|
$37,853.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.01 |
| Max. Negotiated Rate |
$36,339.24 |
| Rate for Payer: Aetna Commercial |
$29,147.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.64
|
| Rate for Payer: Cash Price |
$18,926.69
|
| Rate for Payer: Cigna Commercial |
$31,418.31
|
| Rate for Payer: First Health Commercial |
$35,960.71
|
| Rate for Payer: Humana Commercial |
$32,175.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,039.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,935.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,310.97
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,282.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,118.83
|
| Rate for Payer: PHCS Commercial |
$36,339.24
|
| Rate for Payer: United Healthcare All Payer |
$33,310.97
|
|
