|
STEM ARCS 18X200MM 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 18X200MM 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 18X250MM SPL TPR DST
|
Facility
|
OP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem Medicaid |
$9,082.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Humana KY Medicaid |
$9,082.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,175.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,264.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 18X250MM SPL TPR DST
|
Facility
|
IP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 19*200MM INTLKNG DST
|
Facility
|
IP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 19*200MM INTLKNG DST
|
Facility
|
OP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem Medicaid |
$10,178.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Humana KY Medicaid |
$10,178.41
|
| Rate for Payer: Kentucky WC Medicaid |
$10,282.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,382.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 19*250MM INTLKNG DST
|
Facility
|
IP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 19*250MM INTLKNG DST
|
Facility
|
OP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem Medicaid |
$10,178.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Humana KY Medicaid |
$10,178.41
|
| Rate for Payer: Kentucky WC Medicaid |
$10,282.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,382.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 19*250MM 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 19*250MM 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 19*300MM INTLKNG DST
|
Facility
|
IP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 19*300MM INTLKNG DST
|
Facility
|
OP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem Medicaid |
$10,178.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Humana KY Medicaid |
$10,178.41
|
| Rate for Payer: Kentucky WC Medicaid |
$10,282.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,382.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 19X150MM 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 19X150MM 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 19X150MM 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 19X150MM 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
|
|
|
STEM ARCS 19X190MM 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
|
|
|
STEM ARCS 19X190MM 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 19X200MM 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 19X200MM 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 19X250MM SPL TPR DST
|
Facility
|
OP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem Medicaid |
$9,082.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Humana KY Medicaid |
$9,082.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,175.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,264.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 19X250MM SPL TPR DST
|
Facility
|
IP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 20*200MM INTLKNG DST
|
Facility
|
IP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 20*200MM INTLKNG DST
|
Facility
|
OP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem Medicaid |
$10,178.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Humana KY Medicaid |
$10,178.41
|
| Rate for Payer: Kentucky WC Medicaid |
$10,282.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,382.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
|
STEM ARCS 20*250MM INTLKNG DST
|
Facility
|
IP
|
$29,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.10 |
| Max. Negotiated Rate |
$28,413.12 |
| Rate for Payer: Aetna Commercial |
$22,789.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,085.66
|
| Rate for Payer: Cash Price |
$14,798.50
|
| Rate for Payer: Cigna Commercial |
$24,565.51
|
| Rate for Payer: First Health Commercial |
$28,117.15
|
| Rate for Payer: Humana Commercial |
$25,157.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,269.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,842.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,879.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,045.36
|
| Rate for Payer: Ohio Health Group HMO |
$22,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,749.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,421.93
|
| Rate for Payer: PHCS Commercial |
$28,413.12
|
| Rate for Payer: United Healthcare All Payer |
$26,045.36
|
|
