|
ARCOS STD 13*210+0 CALC 1PC
|
Facility
|
OP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem Medicaid |
$23,640.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Humana KY Medicaid |
$23,640.84
|
| Rate for Payer: Kentucky WC Medicaid |
$23,881.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,115.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 13*210+0 CALC 1PC
|
Facility
|
IP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 14*175 1PC
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 14*175 1PC
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 14*210+0 CALC 1PC
|
Facility
|
IP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 14*210+0 CALC 1PC
|
Facility
|
OP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem Medicaid |
$23,640.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Humana KY Medicaid |
$23,640.84
|
| Rate for Payer: Kentucky WC Medicaid |
$23,881.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,115.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 15*175 1PC
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 15*175 1PC
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 15*210+0 CALC 1PC
|
Facility
|
IP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 15*210+0 CALC 1PC
|
Facility
|
OP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem Medicaid |
$23,640.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Humana KY Medicaid |
$23,640.84
|
| Rate for Payer: Kentucky WC Medicaid |
$23,881.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,115.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 16*175 1PC
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 16*175 1PC
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 16*210+0 CALC 1PC
|
Facility
|
OP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem Medicaid |
$23,640.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Humana KY Medicaid |
$23,640.84
|
| Rate for Payer: Kentucky WC Medicaid |
$23,881.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,115.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 16*210+0 CALC 1PC
|
Facility
|
IP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 18*175 1PC
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 18*175 1PC
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 18*210+0 CALC 1PC
|
Facility
|
IP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 18*210+0 CALC 1PC
|
Facility
|
OP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem Medicaid |
$23,640.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Humana KY Medicaid |
$23,640.84
|
| Rate for Payer: Kentucky WC Medicaid |
$23,881.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,115.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 20*175 1PC
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 20*175 1PC
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 20*210+0 CALC 1PC
|
Facility
|
IP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 20*210+0 CALC 1PC
|
Facility
|
OP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem Medicaid |
$23,640.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Humana KY Medicaid |
$23,640.84
|
| Rate for Payer: Kentucky WC Medicaid |
$23,881.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,115.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
|
ARCOS STD 22*175 1PC
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 22*175 1PC
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
ARCOS STD 22*210+0 CALC 1PC
|
Facility
|
IP
|
$68,743.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,623.01 |
| Max. Negotiated Rate |
$65,993.63 |
| Rate for Payer: Aetna Commercial |
$52,932.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,619.82
|
| Rate for Payer: Cash Price |
$34,371.68
|
| Rate for Payer: Cigna Commercial |
$57,056.99
|
| Rate for Payer: First Health Commercial |
$65,306.19
|
| Rate for Payer: Humana Commercial |
$58,431.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,369.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,732.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,623.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,494.16
|
| Rate for Payer: Ohio Health Group HMO |
$51,557.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,994.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,806.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,432.92
|
| Rate for Payer: PHCS Commercial |
$65,993.63
|
| Rate for Payer: United Healthcare All Payer |
$60,494.16
|
|
