|
NXGN LPS FLX ART SUR AB 1-2 14
|
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
|
|
|
NXGN LPS FLX ART SUR AB 1-2 17
|
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
|
|
|
NXGN LPS FLX ART SUR AB 1-2 17
|
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
|
|
|
NXGN LPS FLX ART SUR AB 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
|
|
|
NXGN LPS FLX ART SUR AB 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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 17
|
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
|
|
|
NXGN LPS FLX ART SUR CD 1-2 17
|
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
|
|
|
NXGN LPS FLX ART SUR 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
|
|
|
NXGN LPS FLX ART SUR 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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 10
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 12
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 14
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 17
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 17
|
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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 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
|
|
|
NXGN LPS FLX ART SUR CD 3-4 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
|
|
