|
NXGN LPS FLX PRECT FEM SZC 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 LPS FLX PRECT FEM SZC 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 LPS FLX PRECT FEM SZD 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 LPS FLX PRECT FEM SZD 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 LPS FLX PRECT FEM SZD 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 LPS FLX PRECT FEM SZD 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 LPS FLX PRECT FEM SZE 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 LPS FLX PRECT FEM SZE 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 LPS FLX PRECT FEM SZE 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 LPS FLX PRECT FEM SZE 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 LPS FLX PRECT FEM SZF 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 LPS FLX PRECT FEM SZF 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 LPS FLX PRECT FEM SZF 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 LPS FLX PRECT FEM SZF 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 LPS FLX PRECT FEM SZG 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 LPS FLX PRECT FEM SZG 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 LPS FLX PRECT FEM SZG 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 LPS FLX PRECT FEM SZG 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 LPS FLX PRECT FEM SZH 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 LPS FLX PRECT FEM SZH 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 LPS FLX PRECT FEM SZH 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 LPS FLX PRECT FEM SZH 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 M FLL BLK TIB AGT 10M S4
|
Facility
|
IP
|
$22,423.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,726.99 |
| Max. Negotiated Rate |
$21,526.36 |
| Rate for Payer: Aetna Commercial |
$17,265.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.17
|
| Rate for Payer: Cash Price |
$11,211.64
|
| Rate for Payer: Cigna Commercial |
$18,611.33
|
| Rate for Payer: First Health Commercial |
$21,302.13
|
| Rate for Payer: Humana Commercial |
$19,059.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,726.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,732.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,817.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,938.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.07
|
| Rate for Payer: PHCS Commercial |
$21,526.36
|
| Rate for Payer: United Healthcare All Payer |
$19,732.50
|
|
|
NXGN M FLL BLK TIB AGT 10M S4
|
Facility
|
OP
|
$22,423.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,726.99 |
| Max. Negotiated Rate |
$21,526.36 |
| Rate for Payer: Aetna Commercial |
$17,265.93
|
| Rate for Payer: Anthem Medicaid |
$7,711.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.17
|
| Rate for Payer: Cash Price |
$11,211.64
|
| Rate for Payer: Cigna Commercial |
$18,611.33
|
| Rate for Payer: First Health Commercial |
$21,302.13
|
| Rate for Payer: Humana Commercial |
$19,059.80
|
| Rate for Payer: Humana KY Medicaid |
$7,711.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,789.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,726.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,732.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,817.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,938.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.07
|
| Rate for Payer: PHCS Commercial |
$21,526.36
|
| Rate for Payer: United Healthcare All Payer |
$19,732.50
|
|
|
NXGN M FLL BLK TIB AGT 10M S5
|
Facility
|
OP
|
$22,423.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,726.99 |
| Max. Negotiated Rate |
$21,526.36 |
| Rate for Payer: Aetna Commercial |
$17,265.93
|
| Rate for Payer: Anthem Medicaid |
$7,711.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,490.17
|
| Rate for Payer: Cash Price |
$11,211.64
|
| Rate for Payer: Cigna Commercial |
$18,611.33
|
| Rate for Payer: First Health Commercial |
$21,302.13
|
| Rate for Payer: Humana Commercial |
$19,059.80
|
| Rate for Payer: Humana KY Medicaid |
$7,711.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,789.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,387.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,548.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,726.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,866.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,732.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,817.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,938.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,508.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,472.07
|
| Rate for Payer: PHCS Commercial |
$21,526.36
|
| Rate for Payer: United Healthcare All Payer |
$19,732.50
|
|
