|
NEXGEN LPSAPTIB SZ5 ST GRN17MM
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN LPSAPTIB SZ5 ST GRN17MM
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 10MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 10MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 12MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 12MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 14MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 14MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 17MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS AP TIB SZ6 GRN 17MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN LPS FLXARTSUR CD 1-2 20
|
Facility
|
OP
|
$7,161.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.30 |
| Max. Negotiated Rate |
$6,874.56 |
| Rate for Payer: Aetna Commercial |
$5,513.97
|
| Rate for Payer: Anthem Medicaid |
$2,462.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,585.58
|
| Rate for Payer: Cash Price |
$3,580.50
|
| Rate for Payer: Cigna Commercial |
$5,943.63
|
| Rate for Payer: First Health Commercial |
$6,802.95
|
| Rate for Payer: Humana Commercial |
$6,086.85
|
| Rate for Payer: Humana KY Medicaid |
$2,462.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,284.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,512.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,301.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,370.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,728.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,230.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,941.09
|
| Rate for Payer: PHCS Commercial |
$6,874.56
|
| Rate for Payer: United Healthcare All Payer |
$6,301.68
|
|
|
NEXGEN LPS FLXARTSUR CD 1-2 20
|
Facility
|
IP
|
$7,161.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.30 |
| Max. Negotiated Rate |
$6,874.56 |
| Rate for Payer: Aetna Commercial |
$5,513.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,585.58
|
| Rate for Payer: Cash Price |
$3,580.50
|
| Rate for Payer: Cigna Commercial |
$5,943.63
|
| Rate for Payer: First Health Commercial |
$6,802.95
|
| Rate for Payer: Humana Commercial |
$6,086.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,284.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,301.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,370.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,728.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,230.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,941.09
|
| Rate for Payer: PHCS Commercial |
$6,874.56
|
| Rate for Payer: United Healthcare All Payer |
$6,301.68
|
|
|
NEXGEN MTL AUG BLK DIS SZC 10M
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK DIS SZC 10M
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK DIS SZC 15M
|
Facility
|
OP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem Medicaid |
$4,149.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Humana KY Medicaid |
$4,149.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,191.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,232.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NEXGEN MTL AUG BLK DIS SZC 15M
|
Facility
|
IP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NEXGEN MTL AUG BLK DIS SZC 20M
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NEXGEN MTL AUG BLK DIS SZC 20M
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NEXGEN MTL AUG BLK DIS SZC 5MM
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK DIS SZC 5MM
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK DIS SZD 10M
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK DIS SZD 10M
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK DIS SZD 15M
|
Facility
|
OP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem Medicaid |
$4,149.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Humana KY Medicaid |
$4,149.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,191.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,232.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NEXGEN MTL AUG BLK DIS SZD 15M
|
Facility
|
IP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NEXGEN MTL AUG BLK DIS SZD 20M
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
