|
NEXEL TOTELB ULNSTM SZ6 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 SZ6 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 SZ6 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 ULN STM SZ6 90M 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 SZ6 90M 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 SZ6 90M 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 SZ6 90M 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
|
|
|
NEXGEN AC ART CR YELLOW 12MM R
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART CR YELLOW 12MM R
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 3-4 YEL 10MM
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 3-4 YEL 10MM
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 3-4 YEL 14MM
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 3-4 YEL 14MM
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 5-6 GRN 10MM
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 5-6 GRN 10MM
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 5-6 GRN 14MM
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SRF 5-6 GRN 14MM
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SURF 12MM BLUE
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SURF 12MM BLUE
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SURF 5-6 GR 12MM
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SURF 5-6 GR 12MM
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SURF BLUE 10MM
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN AC ART SURF BLUE 10MM
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN ANT FEM AGMT PROV SZ C
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN ANT FEM AGMT PROV SZ C
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
