|
LINER G7 NEU ARCOMXL+5 32MM C
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM D
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM D
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM E
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM E
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM F
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM F
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM G
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM G
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM H
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM H
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM I
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 32MM I
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM D
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM D
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM E
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM E
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM F
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM F
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM G
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM G
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM H
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM H
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM I
|
Facility
|
OP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem Medicaid |
$3,787.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Humana KY Medicaid |
$3,787.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,825.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,863.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
|
LINER G7 NEU ARCOMXL+5 36MM I
|
Facility
|
IP
|
$11,013.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.71 |
| Max. Negotiated Rate |
$10,572.65 |
| Rate for Payer: Aetna Commercial |
$8,480.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,590.28
|
| Rate for Payer: Cash Price |
$5,506.59
|
| Rate for Payer: Cigna Commercial |
$9,140.94
|
| Rate for Payer: First Health Commercial |
$10,462.52
|
| Rate for Payer: Humana Commercial |
$9,361.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,030.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,127.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,259.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,202.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.09
|
| Rate for Payer: PHCS Commercial |
$10,572.65
|
| Rate for Payer: United Healthcare All Payer |
$9,691.60
|
|
