|
NXGN LPS FLX PRECT FEM SZF 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 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 SZG 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 SZG 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: Medical Mutual Of Ohio HMO |
$13,259.40
|
| 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 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 SZG 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 SZG 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 SZH 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 SZH 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 SZH 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 SZH 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 M FLL BLK TIB AGT 10M S4
|
Facility
|
OP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem Medicaid |
$7,482.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Humana KY Medicaid |
$7,482.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,558.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,632.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M S4
|
Facility
|
IP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M S5
|
Facility
|
OP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem Medicaid |
$7,482.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Humana KY Medicaid |
$7,482.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,558.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,632.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M S5
|
Facility
|
IP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M S6
|
Facility
|
OP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem Medicaid |
$4,064.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Humana KY Medicaid |
$4,064.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,146.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NXGN M FLL BLK TIB AGT 10M S6
|
Facility
|
IP
|
$11,819.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$11,346.86 |
| Rate for Payer: Aetna Commercial |
$9,101.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.33
|
| Rate for Payer: Cash Price |
$5,909.82
|
| Rate for Payer: Cigna Commercial |
$9,810.31
|
| Rate for Payer: First Health Commercial |
$11,228.67
|
| Rate for Payer: Humana Commercial |
$10,046.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,545.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,864.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,363.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.09
|
| Rate for Payer: PHCS Commercial |
$11,346.86
|
| Rate for Payer: United Healthcare All Payer |
$10,401.29
|
|
|
NXGN M FLL BLK TIB AGT 10M S7
|
Facility
|
IP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M S7
|
Facility
|
OP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem Medicaid |
$7,482.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Humana KY Medicaid |
$7,482.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,558.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,632.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M SZ2
|
Facility
|
OP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem Medicaid |
$7,482.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Humana KY Medicaid |
$7,482.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,558.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,632.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M SZ2
|
Facility
|
IP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M SZ3
|
Facility
|
OP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem Medicaid |
$7,482.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Humana KY Medicaid |
$7,482.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,558.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,632.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M FLL BLK TIB AGT 10M SZ3
|
Facility
|
IP
|
$21,758.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.63 |
| Max. Negotiated Rate |
$20,888.32 |
| Rate for Payer: Aetna Commercial |
$16,754.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,971.76
|
| Rate for Payer: Cash Price |
$10,879.33
|
| Rate for Payer: Cigna Commercial |
$18,059.70
|
| Rate for Payer: First Health Commercial |
$20,670.74
|
| Rate for Payer: Humana Commercial |
$18,494.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,057.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.19
|
| Rate for Payer: PHCS Commercial |
$20,888.32
|
| Rate for Payer: United Healthcare All Payer |
$19,147.63
|
|
|
NXGN M TIB AG BLK 10M LL/RM S2
|
Facility
|
OP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem Medicaid |
$3,895.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Humana KY Medicaid |
$3,895.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,935.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NXGN M TIB AG BLK 10M LL/RM S2
|
Facility
|
IP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
|
NXGN M TIB AG BLK 10M LL/RM S3
|
Facility
|
IP
|
$11,328.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.66 |
| Max. Negotiated Rate |
$10,875.01 |
| Rate for Payer: Aetna Commercial |
$8,722.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,835.95
|
| Rate for Payer: Cash Price |
$5,664.07
|
| Rate for Payer: Cigna Commercial |
$9,402.36
|
| Rate for Payer: First Health Commercial |
$10,761.73
|
| Rate for Payer: Humana Commercial |
$9,628.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,289.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,968.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,496.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,265.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,511.72
|
| Rate for Payer: PHCS Commercial |
$10,875.01
|
| Rate for Payer: United Healthcare All Payer |
$9,968.76
|
|
