|
STEM ARCOS 24X150MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 24X200MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 24X200MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 24X250MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 24X250MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 25X150MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 25X150MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 25X200MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 25X200MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 25X250MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 25X250MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 26X150MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 26X150MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 26X200MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 26X200MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 26X250MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 26X250MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS BRCH SZ A HI 60MM
|
Facility
|
OP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem Medicaid |
$13,196.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Humana KY Medicaid |
$13,196.13
|
| Rate for Payer: Kentucky WC Medicaid |
$13,330.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,460.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
|
STEM ARCOS BRCH SZ A HI 60MM
|
Facility
|
IP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
|
STEM ARCOS BRCH SZ A STD 60MM
|
Facility
|
IP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
|
STEM ARCOS BRCH SZ A STD 60MM
|
Facility
|
OP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem Medicaid |
$13,196.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Humana KY Medicaid |
$13,196.13
|
| Rate for Payer: Kentucky WC Medicaid |
$13,330.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,460.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
|
STEM ARCOS BRCH SZ B HI 60MM
|
Facility
|
OP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem Medicaid |
$13,196.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Humana KY Medicaid |
$13,196.13
|
| Rate for Payer: Kentucky WC Medicaid |
$13,330.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,460.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
|
STEM ARCOS BRCH SZ B HI 60MM
|
Facility
|
IP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
|
STEM ARCOS BRCH SZ B STD 60MM
|
Facility
|
IP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
|
STEM ARCOS BRCH SZ B STD 60MM
|
Facility
|
OP
|
$38,372.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,511.60 |
| Max. Negotiated Rate |
$36,837.12 |
| Rate for Payer: Aetna Commercial |
$29,546.44
|
| Rate for Payer: Anthem Medicaid |
$13,196.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,930.16
|
| Rate for Payer: Cash Price |
$19,186.00
|
| Rate for Payer: Cigna Commercial |
$31,848.76
|
| Rate for Payer: First Health Commercial |
$36,453.40
|
| Rate for Payer: Humana Commercial |
$32,616.20
|
| Rate for Payer: Humana KY Medicaid |
$13,196.13
|
| Rate for Payer: Kentucky WC Medicaid |
$13,330.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,465.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,511.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,460.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,767.36
|
| Rate for Payer: Ohio Health Group HMO |
$28,779.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,383.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,476.68
|
| Rate for Payer: PHCS Commercial |
$36,837.12
|
| Rate for Payer: United Healthcare All Payer |
$33,767.36
|
|
