|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 95907
|
| Hospital Charge Code |
92200011
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$359.04 |
| Rate for Payer: Aetna Commercial |
$287.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$291.72
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$310.42
|
| Rate for Payer: First Health Commercial |
$355.30
|
| Rate for Payer: Humana Commercial |
$317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$306.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$329.12
|
| Rate for Payer: Ohio Health Group HMO |
$280.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.06
|
| Rate for Payer: PHCS Commercial |
$359.04
|
| Rate for Payer: United Healthcare All Payer |
$329.12
|
|
|
NVR CNDJ TST 1-2 STUDIES(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 95907
|
| Hospital Charge Code |
922P0011
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$161.92 |
| Rate for Payer: Ambetter Exchange |
$81.17
|
| Rate for Payer: Anthem Medicaid |
$74.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.40
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$161.92
|
| Rate for Payer: Healthspan PPO |
$94.00
|
| Rate for Payer: Humana Medicaid |
$74.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.09
|
| Rate for Payer: Molina Healthcare Passport |
$74.60
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.52
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.17
|
|
|
NVR CNDJ TST 1-2 STUDIES(T
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 95907
|
| Hospital Charge Code |
922T0011
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.31
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
NVR CNDJ TST 1-2 STUDIES(T
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 95907
|
| Hospital Charge Code |
922T0011
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem Medicaid |
$102.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Humana KY Medicaid |
$102.83
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.31
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
NXGN CR-FLX PRECOAT FEM C LT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM C LT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM C RT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM C RT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM D LT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM D LT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM D RT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM D RT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM E LT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM E LT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM E RT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM E RT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM F LT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM F LT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM F RT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM F RT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM G LT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM G LT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM G RT-
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN CR-FLX PRECOAT FEM G RT-
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
NXGN DST PC AGMT BLCK SZB 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
|
|
