|
STEM S-ROM STD 18*13*160 36 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 18*13*160 36 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 18*13*160 42 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 18*13*160 42 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 20*15*165 36 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 20*15*165 36 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 20*15*165 42 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 20*15*165 42 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 22*17*165 36 NK
|
Facility
|
IP
|
$22,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,832.50 |
| Max. Negotiated Rate |
$21,864.00 |
| Rate for Payer: Aetna Commercial |
$17,536.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,764.50
|
| Rate for Payer: Cash Price |
$11,387.50
|
| Rate for Payer: Cigna Commercial |
$18,903.25
|
| Rate for Payer: First Health Commercial |
$21,636.25
|
| Rate for Payer: Humana Commercial |
$19,358.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,675.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,807.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,832.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,042.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,081.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,814.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,714.75
|
| Rate for Payer: PHCS Commercial |
$21,864.00
|
| Rate for Payer: United Healthcare All Payer |
$20,042.00
|
|
|
STEM S-ROM STD 22*17*165 36 NK
|
Facility
|
OP
|
$22,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,832.50 |
| Max. Negotiated Rate |
$21,864.00 |
| Rate for Payer: Aetna Commercial |
$17,536.75
|
| Rate for Payer: Anthem Medicaid |
$7,832.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,764.50
|
| Rate for Payer: Cash Price |
$11,387.50
|
| Rate for Payer: Cigna Commercial |
$18,903.25
|
| Rate for Payer: First Health Commercial |
$21,636.25
|
| Rate for Payer: Humana Commercial |
$19,358.75
|
| Rate for Payer: Humana KY Medicaid |
$7,832.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,912.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,675.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,807.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,832.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,989.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,042.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,081.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,814.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,714.75
|
| Rate for Payer: PHCS Commercial |
$21,864.00
|
| Rate for Payer: United Healthcare All Payer |
$20,042.00
|
|
|
STEM S-ROM STD 22*17*165 42 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 22*17*165 42 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 24*19*175 36 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 24*19*175 36 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 24*19*175 42 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 24*19*175 42 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 26*21*175 36 NK
|
Facility
|
OP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem Medicaid |
$5,702.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Humana KY Medicaid |
$5,702.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,760.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM S-ROM STD 26*21*175 36 NK
|
Facility
|
IP
|
$16,581.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,974.34 |
| Max. Negotiated Rate |
$15,917.89 |
| Rate for Payer: Aetna Commercial |
$12,767.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,933.29
|
| Rate for Payer: Cash Price |
$8,290.57
|
| Rate for Payer: Cigna Commercial |
$13,762.35
|
| Rate for Payer: First Health Commercial |
$15,752.08
|
| Rate for Payer: Humana Commercial |
$14,093.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,596.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,591.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,435.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,264.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,425.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,440.99
|
| Rate for Payer: PHCS Commercial |
$15,917.89
|
| Rate for Payer: United Healthcare All Payer |
$14,591.40
|
|
|
STEM STD TI/HA NON-CEM 0
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM STD TI/HA NON-CEM 0
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM STD TI/HA NON-CEM 01
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM STD TI/HA NON-CEM 01
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM STD TI/HA NON-CEM 1
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM STD TI/HA NON-CEM 1
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM STD TI/HA NON-CEM 10
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
