|
STEM SEG STR VSS 17MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 18MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 18MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 19MMX130MM
|
Facility
|
IP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SEG STR VSS 19MMX130MM
|
Facility
|
OP
|
$19,049.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,714.95 |
| Max. Negotiated Rate |
$18,287.83 |
| Rate for Payer: Aetna Commercial |
$14,668.36
|
| Rate for Payer: Anthem Medicaid |
$6,551.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,858.86
|
| Rate for Payer: Cash Price |
$9,524.91
|
| Rate for Payer: Cigna Commercial |
$15,811.35
|
| Rate for Payer: First Health Commercial |
$18,097.33
|
| Rate for Payer: Humana Commercial |
$16,192.35
|
| Rate for Payer: Humana KY Medicaid |
$6,551.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,617.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,620.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,058.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,714.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,682.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,763.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,287.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,239.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,573.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,144.38
|
| Rate for Payer: PHCS Commercial |
$18,287.83
|
| Rate for Payer: United Healthcare All Payer |
$16,763.84
|
|
|
STEM SH TAPERED PC STD SZ 11
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPERED PC STD SZ 11
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 4
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 4
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 6
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 6
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 7
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 7
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 8
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC HO SZ 8
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SH TAPER PC STD SZ 4
|
Facility
|
IP
|
$26,401.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,920.38 |
| Max. Negotiated Rate |
$25,345.20 |
| Rate for Payer: Aetna Commercial |
$20,328.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,592.97
|
| Rate for Payer: Cash Price |
$13,200.62
|
| Rate for Payer: Cigna Commercial |
$21,913.04
|
| Rate for Payer: First Health Commercial |
$25,081.19
|
| Rate for Payer: Humana Commercial |
$22,441.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,649.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,484.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,233.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,800.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,969.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,216.86
|
| Rate for Payer: PHCS Commercial |
$25,345.20
|
| Rate for Payer: United Healthcare All Payer |
$23,233.10
|
|
|
STEM SH TAPER PC STD SZ 4
|
Facility
|
OP
|
$26,401.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,920.38 |
| Max. Negotiated Rate |
$25,345.20 |
| Rate for Payer: Aetna Commercial |
$20,328.96
|
| Rate for Payer: Anthem Medicaid |
$9,079.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,592.97
|
| Rate for Payer: Cash Price |
$13,200.62
|
| Rate for Payer: Cigna Commercial |
$21,913.04
|
| Rate for Payer: First Health Commercial |
$25,081.19
|
| Rate for Payer: Humana Commercial |
$22,441.06
|
| Rate for Payer: Humana KY Medicaid |
$9,079.39
|
| Rate for Payer: Kentucky WC Medicaid |
$9,171.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,649.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,484.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,261.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,233.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,800.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,969.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,216.86
|
| Rate for Payer: PHCS Commercial |
$25,345.20
|
| Rate for Payer: United Healthcare All Payer |
$23,233.10
|
|
|
STEM SI-PLUS LAT NON-CEM 1
|
Facility
|
OP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem Medicaid |
$8,341.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Humana KY Medicaid |
$8,341.72
|
| Rate for Payer: Kentucky WC Medicaid |
$8,426.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,509.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
|
STEM SI-PLUS LAT NON-CEM 1
|
Facility
|
IP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
|
STEM SI-PLUS LAT NON-CEM 10
|
Facility
|
IP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
|
STEM SI-PLUS LAT NON-CEM 10
|
Facility
|
OP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem Medicaid |
$8,341.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Humana KY Medicaid |
$8,341.72
|
| Rate for Payer: Kentucky WC Medicaid |
$8,426.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,509.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
|
STEM SI-PLUS LAT NON-CEM 11
|
Facility
|
IP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
|
STEM SI-PLUS LAT NON-CEM 11
|
Facility
|
OP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem Medicaid |
$8,341.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Humana KY Medicaid |
$8,341.72
|
| Rate for Payer: Kentucky WC Medicaid |
$8,426.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,509.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
|
STEM SI-PLUS LAT NON-CEM 2
|
Facility
|
IP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
|
STEM SI-PLUS LAT NON-CEM 2
|
Facility
|
OP
|
$24,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,276.88 |
| Max. Negotiated Rate |
$23,286.00 |
| Rate for Payer: Aetna Commercial |
$18,677.31
|
| Rate for Payer: Anthem Medicaid |
$8,341.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,919.88
|
| Rate for Payer: Cash Price |
$12,128.12
|
| Rate for Payer: Cigna Commercial |
$20,132.69
|
| Rate for Payer: First Health Commercial |
$23,043.44
|
| Rate for Payer: Humana Commercial |
$20,617.81
|
| Rate for Payer: Humana KY Medicaid |
$8,341.72
|
| Rate for Payer: Kentucky WC Medicaid |
$8,426.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,890.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,901.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,509.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,345.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,192.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,102.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,736.81
|
| Rate for Payer: PHCS Commercial |
$23,286.00
|
| Rate for Payer: United Healthcare All Payer |
$21,345.50
|
|
