|
LINER G7 NEU ARCOMXL+5 36MM J
|
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 J
|
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 40MM 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 40MM 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 40MM 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 40MM 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 40MM 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 40MM 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 40MM 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 40MM 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 40MM J
|
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 40MM J
|
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 44MM 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 44MM 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 44MM 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 44MM 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 44MM J
|
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 44MM J
|
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 NEUTRAL E1 28MM A
|
Facility
|
IP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER G7 NEUTRAL E1 28MM A
|
Facility
|
OP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem Medicaid |
$4,147.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Humana KY Medicaid |
$4,147.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER G7 NEUTRAL E1 28MM B
|
Facility
|
OP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem Medicaid |
$4,147.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Humana KY Medicaid |
$4,147.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER G7 NEUTRAL E1 28MM B
|
Facility
|
IP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER G7 NEUTRAL E1 28MM C
|
Facility
|
OP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem Medicaid |
$4,147.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Humana KY Medicaid |
$4,147.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER G7 NEUTRAL E1 28MM C
|
Facility
|
IP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER G7 NEUTRAL E1 28MM D
|
Facility
|
OP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem Medicaid |
$4,147.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Humana KY Medicaid |
$4,147.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
