|
NEXGEN KNEE FEM CUT GUDE D LT
|
Facility
|
OP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem Medicaid |
$3,332.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Humana KY Medicaid |
$3,332.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,366.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,399.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE D LT
|
Facility
|
IP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE D RT
|
Facility
|
OP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem Medicaid |
$3,332.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Humana KY Medicaid |
$3,332.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,366.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,399.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE D RT
|
Facility
|
IP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE E LT
|
Facility
|
OP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem Medicaid |
$3,332.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Humana KY Medicaid |
$3,332.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,366.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,399.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE E LT
|
Facility
|
IP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE E RT
|
Facility
|
IP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE E RT
|
Facility
|
OP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem Medicaid |
$3,332.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Humana KY Medicaid |
$3,332.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,366.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,399.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE F LT
|
Facility
|
OP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem Medicaid |
$3,332.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Humana KY Medicaid |
$3,332.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,366.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,399.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE F LT
|
Facility
|
IP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE F RT
|
Facility
|
IP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN KNEE FEM CUT GUDE F RT
|
Facility
|
OP
|
$9,691.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.86 |
| Max. Negotiated Rate |
$9,303.55 |
| Rate for Payer: Aetna Commercial |
$7,462.22
|
| Rate for Payer: Anthem Medicaid |
$3,332.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,559.14
|
| Rate for Payer: Cash Price |
$4,845.60
|
| Rate for Payer: Cigna Commercial |
$8,043.70
|
| Rate for Payer: First Health Commercial |
$9,206.64
|
| Rate for Payer: Humana Commercial |
$8,237.52
|
| Rate for Payer: Humana KY Medicaid |
$3,332.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,366.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,946.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,152.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,907.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,399.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,528.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,268.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.27
|
| Rate for Payer: PHCS Commercial |
$9,303.55
|
| Rate for Payer: United Healthcare All Payer |
$8,528.26
|
|
|
NEXGEN LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ3 YEL 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 LPS AP TIB SZ4 YEL 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 LPS AP TIB SZ4 YEL 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 LPS AP TIB SZ4 YEL 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 LPS AP TIB SZ4 YEL 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 LPS AP TIB SZ4 YEL 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
|
|
