|
NXGN POST PC AGMT BLK SZE 10MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN POST PC AGMT BLK SZE 10MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN POST PC AGMT BLK SZF 10MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN POST PC AGMT BLK SZF 10MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN POST PC AGMT BLK SZG 10MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN POST PC AGMT BLK SZG 10MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ1
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ1
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ10
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ10
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ2
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ2
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ4+
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ4+
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ9
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ9
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NXGN PROLNG ALL POLY PAT 26MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
NXGN PROLNG ALL POLY PAT 26MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
NXGN PROLNG ALL POLY PAT 29MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
NXGN PROLNG ALL POLY PAT 29MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
NXGN RHART SRF PROV 12M FEM B
|
Facility
|
IP
|
$3,124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.12 |
| Max. Negotiated Rate |
$2,999.04 |
| Rate for Payer: Aetna Commercial |
$2,405.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.72
|
| Rate for Payer: Cash Price |
$1,562.00
|
| Rate for Payer: Cigna Commercial |
$2,592.92
|
| Rate for Payer: First Health Commercial |
$2,967.80
|
| Rate for Payer: Humana Commercial |
$2,655.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,561.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.44
|
| Rate for Payer: PHCS Commercial |
$2,999.04
|
| Rate for Payer: United Healthcare All Payer |
$2,749.12
|
|
|
NXGN RHART SRF PROV 12M FEM B
|
Facility
|
OP
|
$3,124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.12 |
| Max. Negotiated Rate |
$2,999.04 |
| Rate for Payer: Aetna Commercial |
$2,405.48
|
| Rate for Payer: Anthem Medicaid |
$1,074.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.72
|
| Rate for Payer: Cash Price |
$1,562.00
|
| Rate for Payer: Cigna Commercial |
$2,592.92
|
| Rate for Payer: First Health Commercial |
$2,967.80
|
| Rate for Payer: Humana Commercial |
$2,655.40
|
| Rate for Payer: Humana KY Medicaid |
$1,074.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,561.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,095.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.44
|
| Rate for Payer: PHCS Commercial |
$2,999.04
|
| Rate for Payer: United Healthcare All Payer |
$2,749.12
|
|
|
NXGN RHART SRF PROV 12M FEM C
|
Facility
|
OP
|
$3,124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.12 |
| Max. Negotiated Rate |
$2,999.04 |
| Rate for Payer: Aetna Commercial |
$2,405.48
|
| Rate for Payer: Anthem Medicaid |
$1,074.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.72
|
| Rate for Payer: Cash Price |
$1,562.00
|
| Rate for Payer: Cigna Commercial |
$2,592.92
|
| Rate for Payer: First Health Commercial |
$2,967.80
|
| Rate for Payer: Humana Commercial |
$2,655.40
|
| Rate for Payer: Humana KY Medicaid |
$1,074.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,561.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,095.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.44
|
| Rate for Payer: PHCS Commercial |
$2,999.04
|
| Rate for Payer: United Healthcare All Payer |
$2,749.12
|
|
|
NXGN RHART SRF PROV 12M FEM C
|
Facility
|
IP
|
$3,124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.12 |
| Max. Negotiated Rate |
$2,999.04 |
| Rate for Payer: Aetna Commercial |
$2,405.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.72
|
| Rate for Payer: Cash Price |
$1,562.00
|
| Rate for Payer: Cigna Commercial |
$2,592.92
|
| Rate for Payer: First Health Commercial |
$2,967.80
|
| Rate for Payer: Humana Commercial |
$2,655.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,561.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.44
|
| Rate for Payer: PHCS Commercial |
$2,999.04
|
| Rate for Payer: United Healthcare All Payer |
$2,749.12
|
|
|
NXGN RHART SRF PROV 12M FEM D
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
