|
NXGN LPS FLX ART SUR CD 1-2 17
|
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
|
|
|
NXGN LPS FLX ART SUR 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
|
|
|
NXGN LPS FLX ART SUR 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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 17
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 17
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 17
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 17
|
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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 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
|
|
|
NXGN LPS FLX ART SUR CD 5-6 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
|
|
|
NXGN LPS FLX ART SUR EF 3-4 10
|
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
|
|
|
NXGN LPS FLX ART SUR EF 3-4 10
|
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
|
|
