|
NXGN M TIB AG BLK 15M RL/LM S4
|
Facility
|
IP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 15M RL/LM S5
|
Facility
|
IP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 15M RL/LM S5
|
Facility
|
OP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem Medicaid |
$4,149.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Humana KY Medicaid |
$4,149.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,191.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,232.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 15M RL/LM S6
|
Facility
|
OP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem Medicaid |
$4,149.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Humana KY Medicaid |
$4,149.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,191.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,232.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 15M RL/LM S6
|
Facility
|
IP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 15M RL/LM S7
|
Facility
|
IP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 15M RL/LM S7
|
Facility
|
OP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem Medicaid |
$4,149.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Humana KY Medicaid |
$4,149.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,191.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,232.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 20M LL/RM S2
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S2
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S3
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S3
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S4
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S4
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S5
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S5
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S6
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S6
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S7
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M LL/RM S7
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M RL/LM S2
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M RL/LM S2
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M RL/LM S3
|
Facility
|
OP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem Medicaid |
$4,329.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Humana KY Medicaid |
$4,329.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M RL/LM S3
|
Facility
|
IP
|
$12,589.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.79 |
| Max. Negotiated Rate |
$12,085.74 |
| Rate for Payer: Aetna Commercial |
$9,693.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.66
|
| Rate for Payer: Cash Price |
$6,294.65
|
| Rate for Payer: Cigna Commercial |
$10,449.13
|
| Rate for Payer: First Health Commercial |
$11,959.84
|
| Rate for Payer: Humana Commercial |
$10,700.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,323.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.62
|
| Rate for Payer: PHCS Commercial |
$12,085.74
|
| Rate for Payer: United Healthcare All Payer |
$11,078.59
|
|
|
NXGN M TIB AG BLK 20M RL/LM S4
|
Facility
|
OP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem Medicaid |
$4,149.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Humana KY Medicaid |
$4,149.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,191.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,232.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
|
NXGN M TIB AG BLK 20M RL/LM S4
|
Facility
|
IP
|
$12,066.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.90 |
| Max. Negotiated Rate |
$11,583.68 |
| Rate for Payer: Aetna Commercial |
$9,291.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.74
|
| Rate for Payer: Cash Price |
$6,033.17
|
| Rate for Payer: Cigna Commercial |
$10,015.05
|
| Rate for Payer: First Health Commercial |
$11,463.01
|
| Rate for Payer: Humana Commercial |
$10,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,894.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,618.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,653.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,497.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,325.77
|
| Rate for Payer: PHCS Commercial |
$11,583.68
|
| Rate for Payer: United Healthcare All Payer |
$10,618.37
|
|
