|
ARCOS STD 22*210+0 CALC 1PC
|
Facility
|
IP
|
$66,677.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,668.13 |
| Max. Negotiated Rate |
$64,010.80 |
| Rate for Payer: Aetna Commercial |
$51,342.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,008.78
|
| Rate for Payer: Cash Price |
$33,338.96
|
| Rate for Payer: Cigna Commercial |
$55,342.67
|
| Rate for Payer: First Health Commercial |
$63,344.02
|
| Rate for Payer: Humana Commercial |
$56,676.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,675.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,208.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,003.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,676.57
|
| Rate for Payer: Ohio Health Group HMO |
$50,008.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,335.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,668.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,670.16
|
| Rate for Payer: PHCS Commercial |
$64,010.80
|
| Rate for Payer: United Healthcare All Payer |
$58,676.57
|
|
|
ARCOS STD 9.5*175 1PC
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
ARCOS STD 9.5*175 1PC
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
ARCOS STD CAL SZ A +10 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ A +10 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ B +10 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ B +10 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ C +10 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ C +10 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ D +10 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ D +10 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ E +10 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ E +10 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ F +0 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ F +0 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ F +10 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD CAL SZ F +10 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZA +0 50MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZA +0 50MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZA +0 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZA +0 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZ B+0 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZ B+0 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZ C+0 60MM
|
Facility
|
OP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem Medicaid |
$13,467.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Humana KY Medicaid |
$13,467.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,737.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
|
ARCOS STD COND CAL SZ C+0 60MM
|
Facility
|
IP
|
$39,161.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,090.94 |
| Max. Negotiated Rate |
$37,594.66 |
| Rate for Payer: Aetna Commercial |
$30,154.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,545.66
|
| Rate for Payer: Cash Price |
$19,580.55
|
| Rate for Payer: Cigna Commercial |
$32,503.71
|
| Rate for Payer: First Health Commercial |
$37,203.04
|
| Rate for Payer: Humana Commercial |
$33,286.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,112.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,900.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,461.77
|
| Rate for Payer: Ohio Health Group HMO |
$29,370.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,832.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,090.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,139.94
|
| Rate for Payer: PHCS Commercial |
$37,594.66
|
| Rate for Payer: United Healthcare All Payer |
$34,461.77
|
|
