|
STEM ARCOS BRCH SZ C 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 C 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 C 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 C 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 D 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 D 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 D 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 D 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 E 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 E 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 E 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 E 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 F 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 F 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 F 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 F 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 CON SZ A HI 80MM
|
Facility
|
IP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ A HI 80MM
|
Facility
|
OP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem Medicaid |
$13,860.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Humana KY Medicaid |
$13,860.03
|
| Rate for Payer: Kentucky WC Medicaid |
$14,001.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,138.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ A STD 80MM
|
Facility
|
OP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem Medicaid |
$13,860.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Humana KY Medicaid |
$13,860.03
|
| Rate for Payer: Kentucky WC Medicaid |
$14,001.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,138.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ A STD 80MM
|
Facility
|
IP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ B HI 80MM
|
Facility
|
OP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem Medicaid |
$13,860.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Humana KY Medicaid |
$13,860.03
|
| Rate for Payer: Kentucky WC Medicaid |
$14,001.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,138.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ B HI 80MM
|
Facility
|
IP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ B STD 80MM
|
Facility
|
IP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ B STD 80MM
|
Facility
|
OP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem Medicaid |
$13,860.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Humana KY Medicaid |
$13,860.03
|
| Rate for Payer: Kentucky WC Medicaid |
$14,001.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,138.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
|
STEM ARCOS CON SZ C HI 80MM
|
Facility
|
IP
|
$40,302.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,090.75 |
| Max. Negotiated Rate |
$38,690.40 |
| Rate for Payer: Aetna Commercial |
$31,032.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,435.95
|
| Rate for Payer: Cash Price |
$20,151.25
|
| Rate for Payer: Cigna Commercial |
$33,451.07
|
| Rate for Payer: First Health Commercial |
$38,287.38
|
| Rate for Payer: Humana Commercial |
$34,257.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,048.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,743.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,090.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,466.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,226.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,242.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,063.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,808.72
|
| Rate for Payer: PHCS Commercial |
$38,690.40
|
| Rate for Payer: United Healthcare All Payer |
$35,466.20
|
|
