|
ARCOM XL 10^ 36 SZ 24
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
ARCOM XL 10^ 36 SZ 25
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
ARCOM XL 10^ 36 SZ 25
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
ARCOM XL 10^ 36 SZ 26
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
ARCOM XL 10^ 36 SZ 26
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
ARCOM XL44-36 RTNV HMRL BRNG+3
|
Facility
|
OP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem Medicaid |
$2,483.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Humana KY Medicaid |
$2,483.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL44-36 RTNV HMRL BRNG+3
|
Facility
|
IP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG
|
Facility
|
OP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem Medicaid |
$2,483.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Humana KY Medicaid |
$2,483.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG
|
Facility
|
IP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG+3
|
Facility
|
IP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG+3
|
Facility
|
OP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem Medicaid |
$2,483.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Humana KY Medicaid |
$2,483.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL44-41 RTNV HMRL BRNG+3
|
Facility
|
OP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem Medicaid |
$2,483.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Humana KY Medicaid |
$2,483.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL44-41 RTNV HMRL BRNG+3
|
Facility
|
IP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG
|
Facility
|
IP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG
|
Facility
|
OP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem Medicaid |
$2,483.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Humana KY Medicaid |
$2,483.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG+3
|
Facility
|
OP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem Medicaid |
$2,483.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Humana KY Medicaid |
$2,483.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG+3
|
Facility
|
IP
|
$7,220.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.62 |
| Max. Negotiated Rate |
$6,931.34 |
| Rate for Payer: Aetna Commercial |
$5,559.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.72
|
| Rate for Payer: Cash Price |
$3,610.07
|
| Rate for Payer: Cigna Commercial |
$5,992.72
|
| Rate for Payer: First Health Commercial |
$6,859.14
|
| Rate for Payer: Humana Commercial |
$6,137.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,415.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.25
|
| Rate for Payer: PHCS Commercial |
$6,931.34
|
| Rate for Payer: United Healthcare All Payer |
$6,353.73
|
|
|
ARCOMXL G7 10 DEG LNR 28MM A
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
ARCOMXL G7 10 DEG LNR 28MM A
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
ARCOMXL G7 10 DEG LNR 28MM B
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
ARCOMXL G7 10 DEG LNR 28MM B
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
ARCOMXL G7 10 DEG LNR 28MM C
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
ARCOMXL G7 10 DEG LNR 28MM C
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
ARCOMXL G7 10 DEG LNR 28MM D
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
ARCOMXL G7 10 DEG LNR 28MM D
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
