|
STEM REDAPT SLVLS HOSZ22 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 HOSZ23 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 HOSZ23 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 HOSZ24 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 HOSZ24 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 HOSZ25 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 HOSZ25 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 HOSZ26 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 HOSZ26 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 HOSZ27 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 HOSZ27 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 REDPTSLVLSMONO SZ12 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ12 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ13 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ13 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ14 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ14 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ15 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ15 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ16 190MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ16 190MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ16 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ16 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ17 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM REDPTSLVLSMONO SZ17 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
