|
ARCOM XL 10^ 36 SZ 24
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ARCOM XL 10^ 36 SZ 25
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ARCOM XL 10^ 36 SZ 25
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ARCOM XL 10^ 36 SZ 26
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ARCOM XL 10^ 36 SZ 26
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ARCOM XL44-36 RTNV HMRL BRNG+3
|
Facility
|
OP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem Medicaid |
$2,551.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Humana KY Medicaid |
$2,551.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL44-36 RTNV HMRL BRNG+3
|
Facility
|
IP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG
|
Facility
|
IP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG
|
Facility
|
OP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem Medicaid |
$2,551.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Humana KY Medicaid |
$2,551.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG+3
|
Facility
|
IP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-36 STD HMRL BRNG+3
|
Facility
|
OP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem Medicaid |
$2,551.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Humana KY Medicaid |
$2,551.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL44-41 RTNV HMRL BRNG+3
|
Facility
|
OP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem Medicaid |
$2,551.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Humana KY Medicaid |
$2,551.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL44-41 RTNV HMRL BRNG+3
|
Facility
|
IP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG
|
Facility
|
IP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG
|
Facility
|
OP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem Medicaid |
$2,551.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Humana KY Medicaid |
$2,551.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG+3
|
Facility
|
IP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOM XL 44-41 STD HMRL BRNG+3
|
Facility
|
OP
|
$7,420.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.05 |
| Max. Negotiated Rate |
$7,123.34 |
| Rate for Payer: Aetna Commercial |
$5,713.52
|
| Rate for Payer: Anthem Medicaid |
$2,551.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.72
|
| Rate for Payer: Cash Price |
$3,710.07
|
| Rate for Payer: Cigna Commercial |
$6,158.72
|
| Rate for Payer: First Health Commercial |
$7,049.14
|
| Rate for Payer: Humana Commercial |
$6,307.13
|
| Rate for Payer: Humana KY Medicaid |
$2,551.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,476.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,565.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,936.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.90
|
| Rate for Payer: PHCS Commercial |
$7,123.34
|
| Rate for Payer: United Healthcare All Payer |
$6,529.73
|
|
|
ARCOMXL G7 10 DEG LNR 28MM A
|
Facility
|
OP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem Medicaid |
$4,441.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Humana KY Medicaid |
$4,441.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,486.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,530.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
ARCOMXL G7 10 DEG LNR 28MM A
|
Facility
|
IP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
ARCOMXL G7 10 DEG LNR 28MM B
|
Facility
|
IP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
ARCOMXL G7 10 DEG LNR 28MM B
|
Facility
|
OP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem Medicaid |
$4,441.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Humana KY Medicaid |
$4,441.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,486.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,530.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
ARCOMXL G7 10 DEG LNR 28MM C
|
Facility
|
IP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
ARCOMXL G7 10 DEG LNR 28MM C
|
Facility
|
OP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem Medicaid |
$4,441.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Humana KY Medicaid |
$4,441.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,486.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,530.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
ARCOMXL G7 10 DEG LNR 28MM D
|
Facility
|
IP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
ARCOMXL G7 10 DEG LNR 28MM D
|
Facility
|
OP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem Medicaid |
$4,441.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Humana KY Medicaid |
$4,441.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,486.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,530.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
