|
NXGN RH FULL TIB AGMT 10M SZ5
|
Facility
|
IP
|
$8,586.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.25 |
| Max. Negotiated Rate |
$8,243.10 |
| Rate for Payer: Aetna Commercial |
$6,611.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.52
|
| Rate for Payer: Cash Price |
$4,293.28
|
| Rate for Payer: Cigna Commercial |
$7,126.84
|
| Rate for Payer: First Health Commercial |
$8,157.23
|
| Rate for Payer: Humana Commercial |
$7,298.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,040.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,336.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,439.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.83
|
| Rate for Payer: PHCS Commercial |
$8,243.10
|
| Rate for Payer: United Healthcare All Payer |
$7,556.17
|
|
|
NXGN RH FULL TIB AGMT 10M SZ6
|
Facility
|
IP
|
$8,586.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.25 |
| Max. Negotiated Rate |
$8,243.10 |
| Rate for Payer: Aetna Commercial |
$6,611.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.52
|
| Rate for Payer: Cash Price |
$4,293.28
|
| Rate for Payer: Cigna Commercial |
$7,126.84
|
| Rate for Payer: First Health Commercial |
$8,157.23
|
| Rate for Payer: Humana Commercial |
$7,298.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,040.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,336.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,439.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.83
|
| Rate for Payer: PHCS Commercial |
$8,243.10
|
| Rate for Payer: United Healthcare All Payer |
$7,556.17
|
|
|
NXGN RH FULL TIB AGMT 10M SZ6
|
Facility
|
OP
|
$8,586.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.25 |
| Max. Negotiated Rate |
$8,243.10 |
| Rate for Payer: Aetna Commercial |
$6,611.65
|
| Rate for Payer: Anthem Medicaid |
$2,952.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.52
|
| Rate for Payer: Cash Price |
$4,293.28
|
| Rate for Payer: Cigna Commercial |
$7,126.84
|
| Rate for Payer: First Health Commercial |
$8,157.23
|
| Rate for Payer: Humana Commercial |
$7,298.58
|
| Rate for Payer: Humana KY Medicaid |
$2,952.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,040.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,336.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,012.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,439.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.83
|
| Rate for Payer: PHCS Commercial |
$8,243.10
|
| Rate for Payer: United Healthcare All Payer |
$7,556.17
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ1
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem Medicaid |
$1,122.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Humana KY Medicaid |
$1,122.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ1
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ2
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem Medicaid |
$1,122.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Humana KY Medicaid |
$1,122.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ2
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ3
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem Medicaid |
$1,122.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Humana KY Medicaid |
$1,122.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ3
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ4
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ4
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem Medicaid |
$1,122.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Humana KY Medicaid |
$1,122.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ5
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ5
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem Medicaid |
$1,122.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Humana KY Medicaid |
$1,122.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ6
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem Medicaid |
$1,122.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Humana KY Medicaid |
$1,122.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ6
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NXGN RHKNE OFSET REV TIB BM 0^
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.66 |
| Max. Negotiated Rate |
$1,806.72 |
| Rate for Payer: Aetna Commercial |
$1,449.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.96
|
| Rate for Payer: Cash Price |
$941.00
|
| Rate for Payer: Cigna Commercial |
$1,562.06
|
| Rate for Payer: First Health Commercial |
$1,787.90
|
| Rate for Payer: Humana Commercial |
$1,599.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,543.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,656.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.42
|
| Rate for Payer: PHCS Commercial |
$1,806.72
|
| Rate for Payer: United Healthcare All Payer |
$1,656.16
|
|
|
NXGN RHKNE OFSET REV TIB BM 0^
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.66 |
| Max. Negotiated Rate |
$1,806.72 |
| Rate for Payer: Aetna Commercial |
$1,449.14
|
| Rate for Payer: Anthem Medicaid |
$647.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.96
|
| Rate for Payer: Cash Price |
$941.00
|
| Rate for Payer: Cigna Commercial |
$1,562.06
|
| Rate for Payer: First Health Commercial |
$1,787.90
|
| Rate for Payer: Humana Commercial |
$1,599.70
|
| Rate for Payer: Humana KY Medicaid |
$647.22
|
| Rate for Payer: Kentucky WC Medicaid |
$653.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,543.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,656.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.42
|
| Rate for Payer: PHCS Commercial |
$1,806.72
|
| Rate for Payer: United Healthcare All Payer |
$1,656.16
|
|
|
NXGN TRAB MTAL AUG DST C 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 TRAB MTAL AUG DST C 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 TRAB MTAL AUG DST C 15MM
|
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 TRAB MTAL AUG DST C 15MM
|
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 TRAB MTAL AUG DST C 20MM
|
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 TRAB MTAL AUG DST C 20MM
|
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
|
|
|
NYSTAGMUS TESTING:SPONTANEOUS
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 92541
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$53.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$53.65
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$54.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
NYSTAGMUS TESTING:SPONTANEOUS
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 92541
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.68
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
