|
NEXEL TOT ELB HUM STM SZ6 100M
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOT ELB HUM STM SZ6 100M
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOT ELB HUM STM SZ6 150M
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOT ELB HUM STM SZ6 150M
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOT ELBOW ART KIT SZ 4
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
NEXEL TOT ELBOW ART KIT SZ 4
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
NEXEL TOT ELBOW ART KIT SZ 5
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
NEXEL TOT ELBOW ART KIT SZ 5
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
NEXEL TOTELB ULNSTM SZ4 115M L
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ4 115M L
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ4 115M R
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ4 115M R
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULN STM SZ4 75M L
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULN STM SZ4 75M L
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULN STM SZ4 75M R
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULN STM SZ4 75M R
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M L
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M L
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M R
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ5 115M R
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOT ELB ULN STM SZ5 75M
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOT ELB ULN STM SZ5 75M
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULN STM SZ5 75M R
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULN STM SZ5 75M R
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
NEXEL TOTELB ULNSTM SZ6 115M L
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
