|
STEM SI-PLUS LAT NON-CEM 3
|
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 3
|
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 4
|
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 4
|
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 5
|
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 5
|
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 6
|
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 6
|
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 7
|
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 7
|
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 8
|
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 8
|
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 9
|
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 9
|
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 STAN NON-CEM 0
|
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 STAN NON-CEM 0
|
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 STAN NON-CEM 01
|
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 STAN NON-CEM 01
|
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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN NON-CEM 12
|
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
|
|
