|
NEXGEN CR ART SUR C H/5 6 GR20
|
Facility
|
IP
|
$7,161.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.30 |
| Max. Negotiated Rate |
$6,874.56 |
| Rate for Payer: Aetna Commercial |
$5,513.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,585.58
|
| Rate for Payer: Cash Price |
$3,580.50
|
| Rate for Payer: Cigna Commercial |
$5,943.63
|
| Rate for Payer: First Health Commercial |
$6,802.95
|
| Rate for Payer: Humana Commercial |
$6,086.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,284.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,301.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,370.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,728.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,230.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,941.09
|
| Rate for Payer: PHCS Commercial |
$6,874.56
|
| Rate for Payer: United Healthcare All Payer |
$6,301.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR 9
|
Facility
|
IP
|
$7,161.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.30 |
| Max. Negotiated Rate |
$6,874.56 |
| Rate for Payer: Aetna Commercial |
$5,513.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,585.58
|
| Rate for Payer: Cash Price |
$3,580.50
|
| Rate for Payer: Cigna Commercial |
$5,943.63
|
| Rate for Payer: First Health Commercial |
$6,802.95
|
| Rate for Payer: Humana Commercial |
$6,086.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,284.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,301.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,370.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,728.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,230.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,941.09
|
| Rate for Payer: PHCS Commercial |
$6,874.56
|
| Rate for Payer: United Healthcare All Payer |
$6,301.68
|
|
|
NEXGEN CR ART SUR C H/5 6 GR 9
|
Facility
|
OP
|
$7,161.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.30 |
| Max. Negotiated Rate |
$6,874.56 |
| Rate for Payer: Aetna Commercial |
$5,513.97
|
| Rate for Payer: Anthem Medicaid |
$2,462.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,585.58
|
| Rate for Payer: Cash Price |
$3,580.50
|
| Rate for Payer: Cigna Commercial |
$5,943.63
|
| Rate for Payer: First Health Commercial |
$6,802.95
|
| Rate for Payer: Humana Commercial |
$6,086.85
|
| Rate for Payer: Humana KY Medicaid |
$2,462.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,284.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,512.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,301.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,370.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,728.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,230.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,941.09
|
| Rate for Payer: PHCS Commercial |
$6,874.56
|
| Rate for Payer: United Healthcare All Payer |
$6,301.68
|
|
|
NEXGEN CR FEM COMP SZ D LEFT
|
Facility
|
OP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem Medicaid |
$7,110.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Humana KY Medicaid |
$7,110.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,252.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM COMP SZ D LEFT
|
Facility
|
IP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM COMP SZ D RIGHT
|
Facility
|
OP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem Medicaid |
$7,110.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Humana KY Medicaid |
$7,110.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,252.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM COMP SZ D RIGHT
|
Facility
|
IP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM SZ E LEFT
|
Facility
|
IP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM SZ E LEFT
|
Facility
|
OP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem Medicaid |
$7,110.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Humana KY Medicaid |
$7,110.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,252.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM SZ F LEFT
|
Facility
|
OP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem Medicaid |
$7,110.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Humana KY Medicaid |
$7,110.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,252.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM SZ F LEFT
|
Facility
|
IP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM SZ F RIGHT
|
Facility
|
IP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FEM SZ F RIGHT
|
Facility
|
OP
|
$20,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,202.50 |
| Max. Negotiated Rate |
$19,848.00 |
| Rate for Payer: Aetna Commercial |
$15,919.75
|
| Rate for Payer: Anthem Medicaid |
$7,110.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,126.50
|
| Rate for Payer: Cash Price |
$10,337.50
|
| Rate for Payer: Cigna Commercial |
$17,160.25
|
| Rate for Payer: First Health Commercial |
$19,641.25
|
| Rate for Payer: Humana Commercial |
$17,573.75
|
| Rate for Payer: Humana KY Medicaid |
$7,110.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,953.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,258.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,252.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,194.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,987.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,265.75
|
| Rate for Payer: PHCS Commercial |
$19,848.00
|
| Rate for Payer: United Healthcare All Payer |
$18,194.00
|
|
|
NEXGEN CR FLEX OPT FEM SZ C LT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZ C LT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZC LT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZC LT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZ C RT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZ C RT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZC RT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZC RT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZ D LT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZ D LT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZD LT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NEXGEN CR FLEX OPT FEM SZD LT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
