|
STEM ARCOS CON SZ C 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 D 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 D 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 D 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 D 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 E 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 E 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 E 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 E 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 F HI 70MM
|
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 F HI 70MM
|
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 F 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 F 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 F 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 F 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 G HI 70MM
|
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 G HI 70MM
|
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 G 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 G 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 G 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 G 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 ARCS 12X150MM PRX TPR DST
|
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 ARCS 12X150MM PRX TPR DST
|
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 ARCS 12X150MM SPL TPR DST
|
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 ARCS 12X150MM SPL TPR DST
|
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
|
|
