|
GENERATOR VICTORY DCRR 5816
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENERATOR VICTORY DCRR 5816
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENERATOR VICTORY SCRR 5610
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR VICTORY SCRR 5610
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR WW ALPHA PRIME 16
|
Facility
|
IP
|
$79,540.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,340.20 |
| Max. Negotiated Rate |
$76,358.40 |
| Rate for Payer: Aetna Commercial |
$61,245.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,041.20
|
| Rate for Payer: Cash Price |
$39,770.00
|
| Rate for Payer: Cigna Commercial |
$66,018.20
|
| Rate for Payer: First Health Commercial |
$75,563.00
|
| Rate for Payer: Humana Commercial |
$67,609.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,222.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,700.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,862.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$59,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,340.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,657.40
|
| Rate for Payer: PHCS Commercial |
$76,358.40
|
| Rate for Payer: United Healthcare All Payer |
$69,995.20
|
|
|
GENERATOR WW ALPHA PRIME 16
|
Facility
|
OP
|
$79,540.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,340.20 |
| Max. Negotiated Rate |
$76,358.40 |
| Rate for Payer: Aetna Commercial |
$61,245.80
|
| Rate for Payer: Anthem Medicaid |
$27,353.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,041.20
|
| Rate for Payer: Cash Price |
$39,770.00
|
| Rate for Payer: Cigna Commercial |
$66,018.20
|
| Rate for Payer: First Health Commercial |
$75,563.00
|
| Rate for Payer: Humana Commercial |
$67,609.00
|
| Rate for Payer: Humana KY Medicaid |
$27,353.81
|
| Rate for Payer: Kentucky WC Medicaid |
$27,632.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,222.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,700.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,862.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,902.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$59,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,340.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,657.40
|
| Rate for Payer: PHCS Commercial |
$76,358.40
|
| Rate for Payer: United Healthcare All Payer |
$69,995.20
|
|
|
GENERATOR ZEPHYR DDDR 5820
|
Facility
|
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$12,979.20 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
GENERATOR ZEPHYR DDDR 5820
|
Facility
|
OP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$12,979.20 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem Medicaid |
$4,649.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Humana KY Medicaid |
$4,649.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
GENERATR COGNIS RF HE N118/119
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,727.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,727.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,349.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
GENERATR COGNIS RF HE N118/119
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,727.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem Medicaid |
$33,667.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Humana KY Medicaid |
$33,667.81
|
| Rate for Payer: Kentucky WC Medicaid |
$34,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,343.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,727.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,349.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
GENERATR DCCR ENRHYTHM P1501DR
|
Facility
|
IP
|
$20,130.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,616.90 |
| Max. Negotiated Rate |
$19,324.80 |
| Rate for Payer: Aetna Commercial |
$15,500.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,701.40
|
| Rate for Payer: Cash Price |
$10,065.00
|
| Rate for Payer: Cigna Commercial |
$16,707.90
|
| Rate for Payer: First Health Commercial |
$19,123.50
|
| Rate for Payer: Humana Commercial |
$17,110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,506.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,855.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,039.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,714.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,097.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,026.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,240.30
|
| Rate for Payer: PHCS Commercial |
$19,324.80
|
| Rate for Payer: United Healthcare All Payer |
$17,714.40
|
|
|
GENERATR DCCR ENRHYTHM P1501DR
|
Facility
|
OP
|
$20,130.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,616.90 |
| Max. Negotiated Rate |
$19,324.80 |
| Rate for Payer: Aetna Commercial |
$15,500.10
|
| Rate for Payer: Anthem Medicaid |
$6,922.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,701.40
|
| Rate for Payer: Cash Price |
$10,065.00
|
| Rate for Payer: Cigna Commercial |
$16,707.90
|
| Rate for Payer: First Health Commercial |
$19,123.50
|
| Rate for Payer: Humana Commercial |
$17,110.50
|
| Rate for Payer: Humana KY Medicaid |
$6,922.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,993.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,506.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,855.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,039.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,061.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,714.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,097.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,026.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,240.30
|
| Rate for Payer: PHCS Commercial |
$19,324.80
|
| Rate for Payer: United Healthcare All Payer |
$17,714.40
|
|
|
GENESIS II ART INS 9MM SZ 7-8
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
GENESIS II ART INS 9MM SZ 7-8
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
GENESIS II ART INSRT SZ 7-8
|
Facility
|
IP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
GENESIS II ART INSRT SZ 7-8
|
Facility
|
OP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem Medicaid |
$1,748.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Humana KY Medicaid |
$1,748.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,766.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
GENESIS II CM TIB SZ-2 RT
|
Facility
|
OP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem Medicaid |
$3,107.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Humana KY Medicaid |
$3,107.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,169.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GENESIS II CM TIB SZ-2 RT
|
Facility
|
IP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GENESIS II CMT TIB SZ 7 LFT
|
Facility
|
OP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem Medicaid |
$3,107.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Humana KY Medicaid |
$3,107.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,169.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GENESIS II CMT TIB SZ 7 LFT
|
Facility
|
IP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GENESIS II CONE TIB WDG3-4*15M
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II CONE TIB WDG3-4*15M
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II CONETIB WDG 3-4*15M
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II CONETIB WDG 3-4*15M
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II CONETIB WDG 7-8*15M
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
