|
STEM SI-PLUS STAN NON-CEM 12
|
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 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 STAN 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
|
|
|
STEM SI-PLUS STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 STAN 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 SL-PLUS MIA LATERAL SZ 0
|
Facility
|
OP
|
$25,182.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,554.75 |
| Max. Negotiated Rate |
$24,175.20 |
| Rate for Payer: Aetna Commercial |
$19,390.53
|
| Rate for Payer: Anthem Medicaid |
$8,660.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,642.35
|
| Rate for Payer: Cash Price |
$12,591.25
|
| Rate for Payer: Cigna Commercial |
$20,901.47
|
| Rate for Payer: First Health Commercial |
$23,923.38
|
| Rate for Payer: Humana Commercial |
$21,405.12
|
| Rate for Payer: Humana KY Medicaid |
$8,660.26
|
| Rate for Payer: Kentucky WC Medicaid |
$8,748.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,649.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,584.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,554.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,834.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,160.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,886.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,146.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,908.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,375.92
|
| Rate for Payer: PHCS Commercial |
$24,175.20
|
| Rate for Payer: United Healthcare All Payer |
$22,160.60
|
|
|
STEM SL-PLUS MIA LATERAL SZ 0
|
Facility
|
IP
|
$25,182.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,554.75 |
| Max. Negotiated Rate |
$24,175.20 |
| Rate for Payer: Aetna Commercial |
$19,390.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,642.35
|
| Rate for Payer: Cash Price |
$12,591.25
|
| Rate for Payer: Cigna Commercial |
$20,901.47
|
| Rate for Payer: First Health Commercial |
$23,923.38
|
| Rate for Payer: Humana Commercial |
$21,405.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,649.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,584.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,554.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,160.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,886.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,146.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,908.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,375.92
|
| Rate for Payer: PHCS Commercial |
$24,175.20
|
| Rate for Payer: United Healthcare All Payer |
$22,160.60
|
|
|
STEM SL-PLUS MIA LATERAL SZ 2
|
Facility
|
OP
|
$20,726.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.02 |
| Max. Negotiated Rate |
$19,897.68 |
| Rate for Payer: Aetna Commercial |
$15,959.60
|
| Rate for Payer: Anthem Medicaid |
$7,127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,166.86
|
| Rate for Payer: Cash Price |
$10,363.38
|
| Rate for Payer: Cigna Commercial |
$17,203.20
|
| Rate for Payer: First Health Commercial |
$19,690.41
|
| Rate for Payer: Humana Commercial |
$17,617.74
|
| Rate for Payer: Humana KY Medicaid |
$7,127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,200.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,995.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,296.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,218.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,270.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,239.54
|
| Rate for Payer: Ohio Health Group HMO |
$15,545.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,581.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,032.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,301.46
|
| Rate for Payer: PHCS Commercial |
$19,897.68
|
| Rate for Payer: United Healthcare All Payer |
$18,239.54
|
|
|
STEM SL-PLUS MIA LATERAL SZ 2
|
Facility
|
IP
|
$20,726.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.02 |
| Max. Negotiated Rate |
$19,897.68 |
| Rate for Payer: Aetna Commercial |
$15,959.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,166.86
|
| Rate for Payer: Cash Price |
$10,363.38
|
| Rate for Payer: Cigna Commercial |
$17,203.20
|
| Rate for Payer: First Health Commercial |
$19,690.41
|
| Rate for Payer: Humana Commercial |
$17,617.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,995.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,296.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,218.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,239.54
|
| Rate for Payer: Ohio Health Group HMO |
$15,545.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,581.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,032.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,301.46
|
| Rate for Payer: PHCS Commercial |
$19,897.68
|
| Rate for Payer: United Healthcare All Payer |
$18,239.54
|
|
|
STEM SL-PLUS MIA LATERAL SZ 4
|
Facility
|
IP
|
$31,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,573.00 |
| Max. Negotiated Rate |
$30,633.60 |
| Rate for Payer: Aetna Commercial |
$24,570.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,889.80
|
| Rate for Payer: Cash Price |
$15,955.00
|
| Rate for Payer: Cigna Commercial |
$26,485.30
|
| Rate for Payer: First Health Commercial |
$30,314.50
|
| Rate for Payer: Humana Commercial |
$27,123.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,166.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,549.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,573.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,080.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,761.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,017.90
|
| Rate for Payer: PHCS Commercial |
$30,633.60
|
| Rate for Payer: United Healthcare All Payer |
$28,080.80
|
|
|
STEM SL-PLUS MIA LATERAL SZ 4
|
Facility
|
OP
|
$31,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,573.00 |
| Max. Negotiated Rate |
$30,633.60 |
| Rate for Payer: Aetna Commercial |
$24,570.70
|
| Rate for Payer: Anthem Medicaid |
$10,973.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,889.80
|
| Rate for Payer: Cash Price |
$15,955.00
|
| Rate for Payer: Cigna Commercial |
$26,485.30
|
| Rate for Payer: First Health Commercial |
$30,314.50
|
| Rate for Payer: Humana Commercial |
$27,123.50
|
| Rate for Payer: Humana KY Medicaid |
$10,973.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11,085.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,166.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,549.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,573.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,194.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,080.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,761.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,017.90
|
| Rate for Payer: PHCS Commercial |
$30,633.60
|
| Rate for Payer: United Healthcare All Payer |
$28,080.80
|
|
|
STEM SL-PLUS MIA LATERAL SZ 5
|
Facility
|
IP
|
$25,182.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,554.75 |
| Max. Negotiated Rate |
$24,175.20 |
| Rate for Payer: Aetna Commercial |
$19,390.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,642.35
|
| Rate for Payer: Cash Price |
$12,591.25
|
| Rate for Payer: Cigna Commercial |
$20,901.47
|
| Rate for Payer: First Health Commercial |
$23,923.38
|
| Rate for Payer: Humana Commercial |
$21,405.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,649.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,584.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,554.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,160.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,886.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,146.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,908.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,375.92
|
| Rate for Payer: PHCS Commercial |
$24,175.20
|
| Rate for Payer: United Healthcare All Payer |
$22,160.60
|
|
|
STEM SL-PLUS MIA LATERAL SZ 5
|
Facility
|
OP
|
$25,182.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,554.75 |
| Max. Negotiated Rate |
$24,175.20 |
| Rate for Payer: Aetna Commercial |
$19,390.53
|
| Rate for Payer: Anthem Medicaid |
$8,660.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,642.35
|
| Rate for Payer: Cash Price |
$12,591.25
|
| Rate for Payer: Cigna Commercial |
$20,901.47
|
| Rate for Payer: First Health Commercial |
$23,923.38
|
| Rate for Payer: Humana Commercial |
$21,405.12
|
| Rate for Payer: Humana KY Medicaid |
$8,660.26
|
| Rate for Payer: Kentucky WC Medicaid |
$8,748.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,649.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,584.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,554.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,834.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,160.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,886.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,146.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,908.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,375.92
|
| Rate for Payer: PHCS Commercial |
$24,175.20
|
| Rate for Payer: United Healthcare All Payer |
$22,160.60
|
|
