|
NEXGEN CR-FLX PRECOAT FEM F LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NEXGEN CR-FLX PRECOAT FEM F RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NEXGEN CR-FLX PRECOAT FEM F RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NEXGEN CR-FLX PRECOAT FEM G LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NEXGEN CR-FLX PRECOAT FEM G LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NEXGEN CR-FLX PRECOAT FEM G RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NEXGEN CR-FLX PRECOAT FEM G RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NEXGEN CR POROUS FEM SZ E RT
|
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 POROUS FEM SZ E RT
|
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 POROUS FEM SZ G LT
|
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 POROUS FEM SZ G LT
|
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 POROUS FEM SZ G RT
|
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 POROUS FEM SZ G RT
|
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 PRECOAT FEM SZ C LT
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ C LT
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ C RT
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ C RT
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ D LT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
NEXGEN CR PRECOAT FEM SZ D LT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
NEXGEN CR PRECOAT FEM SZ D RT
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ D RT
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ E LT
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ E LT
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ E RT
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
NEXGEN CR PRECOAT FEM SZ E RT
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
