|
NXGN PRECOAT STEM TIB PLT SZ4+
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ9
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
NXGN PRECOAT STEM TIB PLT SZ9
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
NXGN PROLNG ALL POLY PAT 26MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
NXGN PROLNG ALL POLY PAT 26MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
NXGN PROLNG ALL POLY PAT 29MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
NXGN PROLNG ALL POLY PAT 29MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
NXGN RHART SRF PROV 12M FEM B
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 12M FEM B
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem Medicaid |
$1,028.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Humana KY Medicaid |
$1,028.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 12M FEM C
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 12M FEM C
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem Medicaid |
$1,028.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Humana KY Medicaid |
$1,028.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 12M FEM D
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN RHART SRF PROV 12M FEM D
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN RHART SRF PROV 12M FEM E
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem Medicaid |
$1,028.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Humana KY Medicaid |
$1,028.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 12M FEM E
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 12M FEM F
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 12M FEM F
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem Medicaid |
$1,028.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Humana KY Medicaid |
$1,028.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 14M FEM C
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 14M FEM C
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem Medicaid |
$1,028.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Humana KY Medicaid |
$1,028.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 14M FEM D
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN RHART SRF PROV 14M FEM D
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN RHART SRF PROV 14M FEM E
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 14M FEM E
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem Medicaid |
$1,028.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Humana KY Medicaid |
$1,028.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 14M FEM F
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
|
NXGN RHART SRF PROV 14M FEM F
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.00 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,302.30
|
| Rate for Payer: Anthem Medicaid |
$1,028.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.20
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cigna Commercial |
$2,481.70
|
| Rate for Payer: First Health Commercial |
$2,840.50
|
| Rate for Payer: Humana Commercial |
$2,541.50
|
| Rate for Payer: Humana KY Medicaid |
$1,028.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.10
|
| Rate for Payer: PHCS Commercial |
$2,870.40
|
| Rate for Payer: United Healthcare All Payer |
$2,631.20
|
|
