|
STEM ARCOS BRCH SZ D 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 E 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 E 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 E 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 E 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 F 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 F 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 F 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 F 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 CON SZ A HI 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ A HI 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ A STD 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ A STD 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ B HI 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ B HI 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ B STD 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ B STD 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ C HI 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ C HI 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ D HI 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ D HI 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ D STD 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ D STD 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ E HI 80MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
STEM ARCOS CON SZ E HI 80MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
