|
NEXEL TOTELB ULNSTM SZ4 115M L
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ4 115M L
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ4 115M R
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ4 115M R
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ4 75M L
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ4 75M L
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ4 75M R
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ4 75M R
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M L
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M L
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M R
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M R
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOT ELB ULN STM SZ5 75M
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOT ELB ULN STM SZ5 75M
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ5 75M R
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ5 75M R
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ6 115M L
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ6 115M L
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ6 115M R
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULNSTM SZ6 115M R
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ6 90M L
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ6 90M L
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ6 90M R
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXEL TOTELB ULN STM SZ6 90M R
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
NEXGEN AC ART CR YELLOW 12MM R
|
Facility
|
OP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem Medicaid |
$2,274.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Humana KY Medicaid |
$2,274.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
