|
NEXGEN CR AP TIB SZ8 BLUE 10MM
|
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 CR AP TIB SZ8 BLUE 10MM
|
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 CR AP TIB SZ8 BLUE 12MM
|
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 CR AP TIB SZ8 BLUE 12MM
|
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 CR AP TIB SZ8 BLUE 14MM
|
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 CR AP TIB SZ8 BLUE 14MM
|
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 CR AP TIB SZ8 BLUE 17MM
|
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 CR AP TIB SZ8 BLUE 17MM
|
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 CR ART SUR C H/5 6 GR10
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR10
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem Medicaid |
$2,393.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Humana KY Medicaid |
$2,393.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR12
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem Medicaid |
$2,393.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Humana KY Medicaid |
$2,393.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR12
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR14
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR14
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem Medicaid |
$2,393.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Humana KY Medicaid |
$2,393.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR17
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem Medicaid |
$2,393.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Humana KY Medicaid |
$2,393.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR17
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR20
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem Medicaid |
$2,393.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Humana KY Medicaid |
$2,393.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR20
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR 9
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR 9
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem Medicaid |
$2,393.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Humana KY Medicaid |
$2,393.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN CR FEM COMP SZ D LEFT
|
Facility
|
IP
|
$20,057.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,607.41 |
| Max. Negotiated Rate |
$19,254.72 |
| Rate for Payer: Aetna Commercial |
$15,443.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,644.46
|
| Rate for Payer: Cash Price |
$10,028.50
|
| Rate for Payer: Cigna Commercial |
$16,647.31
|
| Rate for Payer: First Health Commercial |
$19,054.15
|
| Rate for Payer: Humana Commercial |
$17,048.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,446.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,802.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,017.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,650.16
|
| Rate for Payer: Ohio Health Group HMO |
$15,042.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,011.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,607.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,217.67
|
| Rate for Payer: PHCS Commercial |
$19,254.72
|
| Rate for Payer: United Healthcare All Payer |
$17,650.16
|
|
|
NEXGEN CR FEM COMP SZ D LEFT
|
Facility
|
OP
|
$20,057.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,607.41 |
| Max. Negotiated Rate |
$19,254.72 |
| Rate for Payer: Aetna Commercial |
$15,443.89
|
| Rate for Payer: Anthem Medicaid |
$6,897.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,644.46
|
| Rate for Payer: Cash Price |
$10,028.50
|
| Rate for Payer: Cigna Commercial |
$16,647.31
|
| Rate for Payer: First Health Commercial |
$19,054.15
|
| Rate for Payer: Humana Commercial |
$17,048.45
|
| Rate for Payer: Humana KY Medicaid |
$6,897.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,967.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,446.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,802.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,017.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,036.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,650.16
|
| Rate for Payer: Ohio Health Group HMO |
$15,042.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,011.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,607.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,217.67
|
| Rate for Payer: PHCS Commercial |
$19,254.72
|
| Rate for Payer: United Healthcare All Payer |
$17,650.16
|
|
|
NEXGEN CR FEM COMP SZ D RIGHT
|
Facility
|
IP
|
$20,057.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,607.41 |
| Max. Negotiated Rate |
$19,254.72 |
| Rate for Payer: Aetna Commercial |
$15,443.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,644.46
|
| Rate for Payer: Cash Price |
$10,028.50
|
| Rate for Payer: Cigna Commercial |
$16,647.31
|
| Rate for Payer: First Health Commercial |
$19,054.15
|
| Rate for Payer: Humana Commercial |
$17,048.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,446.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,802.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,017.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,650.16
|
| Rate for Payer: Ohio Health Group HMO |
$15,042.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,011.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,607.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,217.67
|
| Rate for Payer: PHCS Commercial |
$19,254.72
|
| Rate for Payer: United Healthcare All Payer |
$17,650.16
|
|
|
NEXGEN CR FEM COMP SZ D RIGHT
|
Facility
|
OP
|
$20,057.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,607.41 |
| Max. Negotiated Rate |
$19,254.72 |
| Rate for Payer: Aetna Commercial |
$15,443.89
|
| Rate for Payer: Anthem Medicaid |
$6,897.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,644.46
|
| Rate for Payer: Cash Price |
$10,028.50
|
| Rate for Payer: Cigna Commercial |
$16,647.31
|
| Rate for Payer: First Health Commercial |
$19,054.15
|
| Rate for Payer: Humana Commercial |
$17,048.45
|
| Rate for Payer: Humana KY Medicaid |
$6,897.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,967.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,446.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,802.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,017.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,036.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,650.16
|
| Rate for Payer: Ohio Health Group HMO |
$15,042.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,011.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,607.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,217.67
|
| Rate for Payer: PHCS Commercial |
$19,254.72
|
| Rate for Payer: United Healthcare All Payer |
$17,650.16
|
|
|
NEXGEN CR FEM SZ E LEFT
|
Facility
|
OP
|
$20,057.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,607.41 |
| Max. Negotiated Rate |
$19,254.72 |
| Rate for Payer: Aetna Commercial |
$15,443.89
|
| Rate for Payer: Anthem Medicaid |
$6,897.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,644.46
|
| Rate for Payer: Cash Price |
$10,028.50
|
| Rate for Payer: Cigna Commercial |
$16,647.31
|
| Rate for Payer: First Health Commercial |
$19,054.15
|
| Rate for Payer: Humana Commercial |
$17,048.45
|
| Rate for Payer: Humana KY Medicaid |
$6,897.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,967.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,446.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,802.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,017.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,036.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,650.16
|
| Rate for Payer: Ohio Health Group HMO |
$15,042.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,011.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,607.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,217.67
|
| Rate for Payer: PHCS Commercial |
$19,254.72
|
| Rate for Payer: United Healthcare All Payer |
$17,650.16
|
|
