|
NEXGEN AC ART CR YELLOW 12MM R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN AC ART SRF 3-4 YEL 10MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN AC ART SRF 3-4 YEL 10MM
|
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: First Health Commercial |
$6,283.54
|
| 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: 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
|
|
|
NEXGEN AC ART SRF 3-4 YEL 14MM
|
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
|
|
|
NEXGEN AC ART SRF 3-4 YEL 14MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN AC ART SRF 5-6 GRN 10MM
|
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
|
|
|
NEXGEN AC ART SRF 5-6 GRN 10MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN AC ART SRF 5-6 GRN 14MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN AC ART SRF 5-6 GRN 14MM
|
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
|
|
|
NEXGEN AC ART SURF 12MM BLUE
|
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
|
|
|
NEXGEN AC ART SURF 12MM BLUE
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN AC ART SURF 5-6 GR 12MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN AC ART SURF 5-6 GR 12MM
|
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
|
|
|
NEXGEN AC ART SURF BLUE 10MM
|
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
|
|
|
NEXGEN AC ART SURF BLUE 10MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
NEXGEN ANT FEM AGMT PROV SZ C
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ C
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ D
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ D
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ E
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ E
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ G
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ G
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
