|
NEXGEN LPS AP TIB SZ6 GRN 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 SZ6 GRN 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 FLXARTSUR CD 1-2 20
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN LPS FLXARTSUR CD 1-2 20
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.93 |
| Max. Negotiated Rate |
$6,682.56 |
| Rate for Payer: Aetna Commercial |
$5,359.97
|
| Rate for Payer: Anthem Medicaid |
$2,393.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,429.58
|
| Rate for Payer: Cash Price |
$3,480.50
|
| Rate for Payer: Cigna Commercial |
$5,777.63
|
| Rate for Payer: First Health Commercial |
$6,612.95
|
| Rate for Payer: Humana Commercial |
$5,916.85
|
| Rate for Payer: Humana KY Medicaid |
$2,393.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,708.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,125.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.91
|
| Rate for Payer: PHCS Commercial |
$6,682.56
|
| Rate for Payer: United Healthcare All Payer |
$6,125.68
|
|
|
NEXGEN MTL AUG BLK DIS SZC 10M
|
Facility
|
IP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZC 10M
|
Facility
|
OP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem Medicaid |
$3,895.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Humana KY Medicaid |
$3,895.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,935.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZC 15M
|
Facility
|
OP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem Medicaid |
$4,064.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Humana KY Medicaid |
$4,064.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,146.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NEXGEN MTL AUG BLK DIS SZC 15M
|
Facility
|
IP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NEXGEN MTL AUG BLK DIS SZC 20M
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NEXGEN MTL AUG BLK DIS SZC 20M
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NEXGEN MTL AUG BLK DIS SZC 5MM
|
Facility
|
OP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem Medicaid |
$3,895.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Humana KY Medicaid |
$3,895.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,935.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZC 5MM
|
Facility
|
IP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZD 10M
|
Facility
|
OP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem Medicaid |
$3,895.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Humana KY Medicaid |
$3,895.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,935.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZD 10M
|
Facility
|
IP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZD 15M
|
Facility
|
IP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NEXGEN MTL AUG BLK DIS SZD 15M
|
Facility
|
OP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem Medicaid |
$4,064.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Humana KY Medicaid |
$4,064.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,146.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NEXGEN MTL AUG BLK DIS SZD 20M
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NEXGEN MTL AUG BLK DIS SZD 20M
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NEXGEN MTL AUG BLK DIS SZD 5M
|
Facility
|
IP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZD 5M
|
Facility
|
OP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem Medicaid |
$3,895.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Humana KY Medicaid |
$3,895.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,935.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZE 10M
|
Facility
|
IP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZE 10M
|
Facility
|
OP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem Medicaid |
$3,895.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Humana KY Medicaid |
$3,895.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,935.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NEXGEN MTL AUG BLK DIS SZE 15M
|
Facility
|
OP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem Medicaid |
$4,064.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Humana KY Medicaid |
$4,064.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,146.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NEXGEN MTL AUG BLK DIS SZE 15M
|
Facility
|
IP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NEXGEN MTL AUG BLK DIS SZE 20M
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
