|
NXGN M TIB AG BLK 20M LL/RM S4
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M LL/RM S5
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M LL/RM S5
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M LL/RM S6
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M LL/RM S6
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M LL/RM S7
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M LL/RM S7
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM S2
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM S2
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM S3
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM S3
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM S4
|
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 TIB AG BLK 20M RL/LM S4
|
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 TIB AG BLK 20M RL/LM S5
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM S5
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM 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 TIB AG BLK 20M RL/LM 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 TIB AG BLK 20M RL/LM S7
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 20M RL/LM S7
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 30M LL/RM S3
|
Facility
|
IP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 30M LL/RM S3
|
Facility
|
OP
|
$12,339.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.17 |
| Max. Negotiated Rate |
$11,846.18 |
| Rate for Payer: Aetna Commercial |
$9,501.62
|
| Rate for Payer: Anthem Medicaid |
$4,243.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,625.02
|
| Rate for Payer: Cash Price |
$6,169.89
|
| Rate for Payer: Cigna Commercial |
$10,242.01
|
| Rate for Payer: First Health Commercial |
$11,722.78
|
| Rate for Payer: Humana Commercial |
$10,488.80
|
| Rate for Payer: Humana KY Medicaid |
$4,243.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,859.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.33
|
| Rate for Payer: PHCS Commercial |
$11,846.18
|
| Rate for Payer: United Healthcare All Payer |
$10,859.00
|
|
|
NXGN M TIB AG BLK 30M LL/RM S4
|
Facility
|
IP
|
$13,322.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.97 |
| Max. Negotiated Rate |
$12,789.92 |
| Rate for Payer: Aetna Commercial |
$10,258.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,391.81
|
| Rate for Payer: Cash Price |
$6,661.41
|
| Rate for Payer: Cigna Commercial |
$11,057.95
|
| Rate for Payer: First Health Commercial |
$12,656.69
|
| Rate for Payer: Humana Commercial |
$11,324.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,832.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,996.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,724.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,992.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,130.08
|
| Rate for Payer: PHCS Commercial |
$12,789.92
|
| Rate for Payer: United Healthcare All Payer |
$11,724.09
|
|
|
NXGN M TIB AG BLK 30M LL/RM S4
|
Facility
|
OP
|
$13,322.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.97 |
| Max. Negotiated Rate |
$12,789.92 |
| Rate for Payer: Aetna Commercial |
$10,258.58
|
| Rate for Payer: Anthem Medicaid |
$4,581.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,391.81
|
| Rate for Payer: Cash Price |
$6,661.41
|
| Rate for Payer: Cigna Commercial |
$11,057.95
|
| Rate for Payer: First Health Commercial |
$12,656.69
|
| Rate for Payer: Humana Commercial |
$11,324.41
|
| Rate for Payer: Humana KY Medicaid |
$4,581.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,628.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,832.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,996.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,673.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,724.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,992.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,130.08
|
| Rate for Payer: PHCS Commercial |
$12,789.92
|
| Rate for Payer: United Healthcare All Payer |
$11,724.09
|
|
|
NXGN M TIB AG BLK 30M LL/RM S5
|
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 TIB AG BLK 30M LL/RM S5
|
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
|
|
