|
NXGN M TIB AG BLK 20M RL/LM 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 RL/LM 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 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 20M 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 20M RL/LM 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 RL/LM 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 30M 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 30M 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 30M LL/RM S4
|
Facility
|
OP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem Medicaid |
$4,669.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Humana KY Medicaid |
$4,669.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,716.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,763.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M LL/RM S4
|
Facility
|
IP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M LL/RM 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 30M LL/RM 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 30M LL/RM S6
|
Facility
|
IP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M LL/RM S6
|
Facility
|
OP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem Medicaid |
$4,669.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Humana KY Medicaid |
$4,669.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,716.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,763.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M RL/LM S3
|
Facility
|
OP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem Medicaid |
$4,669.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Humana KY Medicaid |
$4,669.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,716.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,763.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M RL/LM S3
|
Facility
|
IP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M RL/LM S4
|
Facility
|
IP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M RL/LM S4
|
Facility
|
OP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem Medicaid |
$4,669.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Humana KY Medicaid |
$4,669.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,716.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,763.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M RL/LM S5
|
Facility
|
IP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M RL/LM S5
|
Facility
|
OP
|
$13,577.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,073.32 |
| Max. Negotiated Rate |
$13,034.64 |
| Rate for Payer: Aetna Commercial |
$10,454.87
|
| Rate for Payer: Anthem Medicaid |
$4,669.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,590.65
|
| Rate for Payer: Cash Price |
$6,788.87
|
| Rate for Payer: Cigna Commercial |
$11,269.53
|
| Rate for Payer: First Health Commercial |
$12,898.86
|
| Rate for Payer: Humana Commercial |
$11,541.09
|
| Rate for Payer: Humana KY Medicaid |
$4,669.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,716.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,133.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,020.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,073.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,763.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,948.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,183.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,862.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,368.65
|
| Rate for Payer: PHCS Commercial |
$13,034.64
|
| Rate for Payer: United Healthcare All Payer |
$11,948.42
|
|
|
NXGN M TIB AG BLK 30M 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 30M 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 5M LL/RM S2
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NXGN M TIB AG BLK 5M LL/RM S2
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NXGN M TIB AG BLK 5M LL/RM S3
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
