|
NXGN LPS FLX ART SUR GH 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 GH 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 GH 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 PRECT FEM SZA LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZA LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZA RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZA RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZB LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZB LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZB RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZB RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZC LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZC LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZC RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZC RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZD LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZD LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZD RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZD RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZE LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZE LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZE RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZE RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZF LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
NXGN LPS FLX PRECT FEM SZF LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
