|
STEM ARCS 15*200MM INTLKNG DST
|
Facility
|
OP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem Medicaid |
$9,884.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Humana KY Medicaid |
$9,884.06
|
| Rate for Payer: Kentucky WC Medicaid |
$9,984.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,082.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 15*200MM INTLKNG DST
|
Facility
|
IP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 15*250MM INTLKNG DST
|
Facility
|
IP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 15*250MM INTLKNG DST
|
Facility
|
OP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem Medicaid |
$9,884.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Humana KY Medicaid |
$9,884.06
|
| Rate for Payer: Kentucky WC Medicaid |
$9,984.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,082.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 15*300MM INTLKNG DST
|
Facility
|
OP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem Medicaid |
$9,884.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Humana KY Medicaid |
$9,884.06
|
| Rate for Payer: Kentucky WC Medicaid |
$9,984.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,082.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 15*300MM INTLKNG DST
|
Facility
|
IP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 15X150MM PRX TPR DST
|
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 ARCS 15X150MM PRX TPR DST
|
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 ARCS 15X150MM SPL TPR DST
|
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 ARCS 15X150MM SPL TPR DST
|
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 ARCS 15X190MM SPL TPR DST
|
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 ARCS 15X190MM SPL TPR DST
|
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 ARCS 15X200MM PRX TPR DST
|
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 ARCS 15X200MM PRX TPR DST
|
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 ARCS 15X250MM PRX TPR DST
|
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 ARCS 15X250MM PRX TPR DST
|
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 ARCS 15X250MM SPL TPR DST
|
Facility
|
IP
|
$25,640.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,333.21 |
| Max. Negotiated Rate |
$24,614.44 |
| Rate for Payer: Aetna Commercial |
$19,742.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,999.23
|
| Rate for Payer: Cash Price |
$12,820.02
|
| Rate for Payer: Cigna Commercial |
$21,281.23
|
| Rate for Payer: First Health Commercial |
$24,358.04
|
| Rate for Payer: Humana Commercial |
$21,794.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,024.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,922.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,692.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,563.24
|
| Rate for Payer: Ohio Health Group HMO |
$19,230.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,128.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,333.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,948.41
|
| Rate for Payer: PHCS Commercial |
$24,614.44
|
| Rate for Payer: United Healthcare All Payer |
$22,563.24
|
|
|
STEM ARCS 15X250MM SPL TPR DST
|
Facility
|
OP
|
$25,640.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,333.21 |
| Max. Negotiated Rate |
$24,614.44 |
| Rate for Payer: Aetna Commercial |
$19,742.83
|
| Rate for Payer: Anthem Medicaid |
$8,817.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,999.23
|
| Rate for Payer: Cash Price |
$12,820.02
|
| Rate for Payer: Cigna Commercial |
$21,281.23
|
| Rate for Payer: First Health Commercial |
$24,358.04
|
| Rate for Payer: Humana Commercial |
$21,794.03
|
| Rate for Payer: Humana KY Medicaid |
$8,817.61
|
| Rate for Payer: Kentucky WC Medicaid |
$8,907.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,024.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,922.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,692.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,994.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,563.24
|
| Rate for Payer: Ohio Health Group HMO |
$19,230.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,128.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,333.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,948.41
|
| Rate for Payer: PHCS Commercial |
$24,614.44
|
| Rate for Payer: United Healthcare All Payer |
$22,563.24
|
|
|
STEM ARCS 16*200MM INTLKNG DST
|
Facility
|
IP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 16*200MM INTLKNG DST
|
Facility
|
OP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem Medicaid |
$9,884.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Humana KY Medicaid |
$9,884.06
|
| Rate for Payer: Kentucky WC Medicaid |
$9,984.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,082.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 16*250MM INTLKNG DST
|
Facility
|
OP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem Medicaid |
$9,884.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Humana KY Medicaid |
$9,884.06
|
| Rate for Payer: Kentucky WC Medicaid |
$9,984.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,082.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 16*250MM INTLKNG DST
|
Facility
|
IP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 16*300MM INTLKNG DST
|
Facility
|
IP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 16*300MM INTLKNG DST
|
Facility
|
OP
|
$28,741.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.34 |
| Max. Negotiated Rate |
$27,591.44 |
| Rate for Payer: Aetna Commercial |
$22,130.63
|
| Rate for Payer: Anthem Medicaid |
$9,884.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,418.04
|
| Rate for Payer: Cash Price |
$14,370.54
|
| Rate for Payer: Cigna Commercial |
$23,855.10
|
| Rate for Payer: First Health Commercial |
$27,304.03
|
| Rate for Payer: Humana Commercial |
$24,429.92
|
| Rate for Payer: Humana KY Medicaid |
$9,884.06
|
| Rate for Payer: Kentucky WC Medicaid |
$9,984.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,567.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,210.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,622.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,082.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,292.15
|
| Rate for Payer: Ohio Health Group HMO |
$21,555.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,748.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,909.73
|
| Rate for Payer: PHCS Commercial |
$27,591.44
|
| Rate for Payer: United Healthcare All Payer |
$25,292.15
|
|
|
STEM ARCS 16X150MM PRX TPR DST
|
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
|
|
