|
NEXGEN CR-FLEX POROUS FEM D LT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM D RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM D RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM E LT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM E LT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM E RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM E RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM F LT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM F LT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM F RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM F RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM G LT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM G LT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM G RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLEX POROUS FEM G RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR FLEX PROLONG SURF 12
|
Facility
|
OP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem Medicaid |
$2,453.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Humana KY Medicaid |
$2,453.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
NEXGEN CR FLEX PROLONG SURF 12
|
Facility
|
IP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
NEXGEN CR-FLX POROUS FEM C LT-
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLX POROUS FEM C LT-
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLX POROUS FEM C RT-
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLX POROUS FEM C RT-
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLX POROUS FEM D LT-
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLX POROUS FEM D LT-
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLX POROUS FEM D RT-
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
NEXGEN CR-FLX POROUS FEM D RT-
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
