|
SULAR(NISOLDIPINE)40 MG TABLET
|
Facility
|
IP
|
$31.35
|
|
|
Service Code
|
NDC 378222401
|
| Hospital Charge Code |
25001449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$30.10 |
| Rate for Payer: Aetna Commercial |
$24.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.45
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cigna Commercial |
$26.02
|
| Rate for Payer: First Health Commercial |
$29.78
|
| Rate for Payer: Humana Commercial |
$26.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.59
|
| Rate for Payer: Ohio Health Group HMO |
$23.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.72
|
| Rate for Payer: PHCS Commercial |
$30.10
|
| Rate for Payer: United Healthcare All Payer |
$27.59
|
|
|
SULAR(NISOLDIPINE)40 MG TABLET
|
Facility
|
OP
|
$31.35
|
|
|
Service Code
|
NDC 378222401
|
| Hospital Charge Code |
25001449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$30.10 |
| Rate for Payer: Aetna Commercial |
$24.14
|
| Rate for Payer: Anthem Medicaid |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.45
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cigna Commercial |
$26.02
|
| Rate for Payer: First Health Commercial |
$29.78
|
| Rate for Payer: Humana Commercial |
$26.65
|
| Rate for Payer: Humana KY Medicaid |
$10.78
|
| Rate for Payer: Kentucky WC Medicaid |
$10.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.59
|
| Rate for Payer: Ohio Health Group HMO |
$23.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.72
|
| Rate for Payer: PHCS Commercial |
$30.10
|
| Rate for Payer: United Healthcare All Payer |
$27.59
|
|
|
SULFADIAZINE 500MG TABLET
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 42806075760
|
| Hospital Charge Code |
25001450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$31.71 |
| Rate for Payer: Aetna Commercial |
$25.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.76
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cigna Commercial |
$27.41
|
| Rate for Payer: First Health Commercial |
$31.38
|
| Rate for Payer: Humana Commercial |
$28.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.07
|
| Rate for Payer: Ohio Health Group HMO |
$24.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.24
|
| Rate for Payer: PHCS Commercial |
$31.71
|
| Rate for Payer: United Healthcare All Payer |
$29.07
|
|
|
SULFADIAZINE 500MG TABLET
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 42806075760
|
| Hospital Charge Code |
25001450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$31.71 |
| Rate for Payer: Aetna Commercial |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$11.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.76
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cigna Commercial |
$27.41
|
| Rate for Payer: First Health Commercial |
$31.38
|
| Rate for Payer: Humana Commercial |
$28.08
|
| Rate for Payer: Humana KY Medicaid |
$11.36
|
| Rate for Payer: Kentucky WC Medicaid |
$11.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.07
|
| Rate for Payer: Ohio Health Group HMO |
$24.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.24
|
| Rate for Payer: PHCS Commercial |
$31.71
|
| Rate for Payer: United Healthcare All Payer |
$29.07
|
|
|
SULFASALAZINE EC 500 MG TABLET
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 59762010405
|
| Hospital Charge Code |
25001452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
SULFASALAZINE EC 500 MG TABLET
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 59762010405
|
| Hospital Charge Code |
25001452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 3
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 3
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 4
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 4
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 5
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 5
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 6
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 6
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 7
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 7
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 8
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM HI OFFSET SZ 8
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM STD OFFSET SZ
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM STD OFFSET SZ
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM STD OFFST SZ 4
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM STD OFFST SZ 4
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM STD OFFST SZ 5
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM STD OFFST SZ 5
|
Facility
|
IP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
|
SUMMIT CEM STEM STD OFFST SZ 6
|
Facility
|
OP
|
$15,406.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.79 |
| Max. Negotiated Rate |
$14,789.84 |
| Rate for Payer: Aetna Commercial |
$11,862.68
|
| Rate for Payer: Anthem Medicaid |
$5,298.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,016.74
|
| Rate for Payer: Cash Price |
$7,703.04
|
| Rate for Payer: Cigna Commercial |
$12,787.05
|
| Rate for Payer: First Health Commercial |
$14,635.78
|
| Rate for Payer: Humana Commercial |
$13,095.17
|
| Rate for Payer: Humana KY Medicaid |
$5,298.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,352.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,632.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,369.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,621.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,557.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,554.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,002.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,775.88
|
| Rate for Payer: PHCS Commercial |
$14,789.84
|
| Rate for Payer: United Healthcare All Payer |
$13,557.35
|
|
