|
LINER G7 NEU ACE +5MM*44MM I
|
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
|
|
|
LINER G7 NEU ACE +5MM*44MM I
|
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
|
|
|
LINER G7 NEU ACE +5MM*44MM J
|
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
|
|
|
LINER G7 NEU ACE +5MM*44MM J
|
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
|
|
|
LINER G7 NEU ARCOMXL+5 28MM A
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM A
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM D
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM D
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM E
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM E
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM F
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM F
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM G
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 28MM G
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM B
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM B
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM C
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM C
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM D
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM D
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM E
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM E
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM F
|
Facility
|
IP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM F
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
|
LINER G7 NEU ARCOMXL+5 32MM G
|
Facility
|
OP
|
$11,255.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.63 |
| Max. Negotiated Rate |
$10,805.22 |
| Rate for Payer: Aetna Commercial |
$8,666.69
|
| Rate for Payer: Anthem Medicaid |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,779.24
|
| Rate for Payer: Cash Price |
$5,627.72
|
| Rate for Payer: Cigna Commercial |
$9,342.02
|
| Rate for Payer: First Health Commercial |
$10,692.67
|
| Rate for Payer: Humana Commercial |
$9,567.12
|
| Rate for Payer: Humana KY Medicaid |
$3,870.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,910.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,229.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,306.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,904.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,441.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,004.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,766.25
|
| Rate for Payer: PHCS Commercial |
$10,805.22
|
| Rate for Payer: United Healthcare All Payer |
$9,904.79
|
|
