|
STEM ARCOS 25X200MM CYL DIST
|
Facility
|
OP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem Medicaid |
$7,740.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Humana KY Medicaid |
$7,740.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,895.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 25X200MM CYL DIST
|
Facility
|
IP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 25X250MM CYL DIST
|
Facility
|
IP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 25X250MM CYL DIST
|
Facility
|
OP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem Medicaid |
$7,740.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Humana KY Medicaid |
$7,740.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,895.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 26X150MM CYL DIST
|
Facility
|
IP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 26X150MM CYL DIST
|
Facility
|
OP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem Medicaid |
$7,740.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Humana KY Medicaid |
$7,740.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,895.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 26X200MM CYL DIST
|
Facility
|
OP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem Medicaid |
$7,740.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Humana KY Medicaid |
$7,740.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,895.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 26X200MM CYL DIST
|
Facility
|
IP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 26X250MM CYL DIST
|
Facility
|
OP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem Medicaid |
$7,740.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Humana KY Medicaid |
$7,740.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,895.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS 26X250MM CYL DIST
|
Facility
|
IP
|
$22,508.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,926.08 |
| Max. Negotiated Rate |
$21,608.01 |
| Rate for Payer: Aetna Commercial |
$17,331.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,556.51
|
| Rate for Payer: Cash Price |
$11,254.17
|
| Rate for Payer: Cigna Commercial |
$18,681.92
|
| Rate for Payer: First Health Commercial |
$21,382.92
|
| Rate for Payer: Humana Commercial |
$19,132.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,456.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,611.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,752.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,807.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,881.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,977.59
|
| Rate for Payer: PHCS Commercial |
$21,608.01
|
| Rate for Payer: United Healthcare All Payer |
$19,807.34
|
|
|
STEM ARCOS BRCH SZ A HI 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ A HI 60MM
|
Facility
|
IP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ A STD 60MM
|
Facility
|
IP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ A STD 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ B HI 60MM
|
Facility
|
IP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ B HI 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ B STD 60MM
|
Facility
|
IP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ B STD 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ C HI 60MM
|
Facility
|
IP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ C HI 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ C STD 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ C STD 60MM
|
Facility
|
IP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ D HI 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ D HI 60MM
|
Facility
|
IP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
|
STEM ARCOS BRCH SZ D STD 60MM
|
Facility
|
OP
|
$37,282.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,846.67 |
| Max. Negotiated Rate |
$35,790.80 |
| Rate for Payer: Aetna Commercial |
$28,707.20
|
| Rate for Payer: Anthem Medicaid |
$12,821.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,080.02
|
| Rate for Payer: Cash Price |
$18,641.04
|
| Rate for Payer: Cigna Commercial |
$30,944.13
|
| Rate for Payer: First Health Commercial |
$35,417.98
|
| Rate for Payer: Humana Commercial |
$31,689.77
|
| Rate for Payer: Humana KY Medicaid |
$12,821.31
|
| Rate for Payer: Kentucky WC Medicaid |
$12,951.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,571.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,514.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,184.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,078.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,808.23
|
| Rate for Payer: Ohio Health Group HMO |
$27,961.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,456.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,846.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,557.44
|
| Rate for Payer: PHCS Commercial |
$35,790.80
|
| Rate for Payer: United Healthcare All Payer |
$32,808.23
|
|
