|
GENESIS II SING PEG RES PT32MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II SING PEG RES PT32MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II SING PEG RES PT35MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II SING PEG RES PT35MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II TIB BASEPLATE SZ2 L
|
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 TIB BASEPLATE SZ2 L
|
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 TIB BASEPLATE SZ2 R
|
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 TIB BASEPLATE SZ2 R
|
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 TIB BASEPLATE SZ3 L
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GENESIS II TIB BASEPLATE SZ3 L
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GENESIS II TIB BASEPLATE SZ3 R
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GENESIS II TIB BASEPLATE SZ3 R
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GENESIS II TIB BASEPLAT SZ 4 R
|
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 TIB BASEPLAT SZ 4 R
|
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 TIB BASEPLAT SZ 7 R
|
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 TIB BASEPLAT SZ 7 R
|
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
|
|
|
GENETIC COUNSELING 30 MIN
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 96040
|
| Hospital Charge Code |
761P2634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$59.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$47.01
|
| Rate for Payer: Healthspan PPO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.58
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
|
|
GENETIC COUNSELING 30 MIN
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 96040
|
| Hospital Charge Code |
76102634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$59.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$47.01
|
| Rate for Payer: Healthspan PPO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.58
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
|
|
GENETIC COUNSELING 30 MIN
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 96040
|
| Hospital Charge Code |
76102634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.80
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
GENETIC COUNSELING 30 MIN
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 96040
|
| Hospital Charge Code |
76102634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.80
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
GENETIC TSTG SEVERE INH COND
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 81443
|
| Hospital Charge Code |
30002060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$365.56 |
| Max. Negotiated Rate |
$2,699.52 |
| Rate for Payer: Aetna Commercial |
$2,165.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,258.04
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$2,333.96
|
| Rate for Payer: First Health Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial |
$2,390.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,075.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,474.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,109.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$562.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$871.72
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
GENETIC TSTG SEVERE INH COND
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 81443
|
| Hospital Charge Code |
30002060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$365.56 |
| Max. Negotiated Rate |
$3,427.98 |
| Rate for Payer: Aetna Commercial |
$2,165.24
|
| Rate for Payer: Anthem Medicaid |
$2,448.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,448.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,258.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,427.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,448.56
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$2,333.96
|
| Rate for Payer: First Health Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial |
$2,390.20
|
| Rate for Payer: Humana KY Medicaid |
$2,448.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,448.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,473.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,075.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,938.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,497.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,474.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,109.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$562.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$871.72
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
GEN II CONST ART ISRT 3-4*9MM
|
Facility
|
OP
|
$5,521.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.80 |
| Max. Negotiated Rate |
$5,300.64 |
| Rate for Payer: Aetna Commercial |
$4,251.56
|
| Rate for Payer: Anthem Medicaid |
$1,898.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,306.77
|
| Rate for Payer: Cash Price |
$2,760.75
|
| Rate for Payer: Cigna Commercial |
$4,582.84
|
| Rate for Payer: First Health Commercial |
$5,245.42
|
| Rate for Payer: Humana Commercial |
$4,693.28
|
| Rate for Payer: Humana KY Medicaid |
$1,898.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,918.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,527.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,936.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,858.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,141.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.66
|
| Rate for Payer: PHCS Commercial |
$5,300.64
|
| Rate for Payer: United Healthcare All Payer |
$4,858.92
|
|
|
GEN II CONST ART ISRT 3-4*9MM
|
Facility
|
IP
|
$5,521.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.80 |
| Max. Negotiated Rate |
$5,300.64 |
| Rate for Payer: Aetna Commercial |
$4,251.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,306.77
|
| Rate for Payer: Cash Price |
$2,760.75
|
| Rate for Payer: Cigna Commercial |
$4,582.84
|
| Rate for Payer: First Health Commercial |
$5,245.42
|
| Rate for Payer: Humana Commercial |
$4,693.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,527.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,858.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,141.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.66
|
| Rate for Payer: PHCS Commercial |
$5,300.64
|
| Rate for Payer: United Healthcare All Payer |
$4,858.92
|
|
|
GEN II CONST ART ISRT 5-6*9MM
|
Facility
|
IP
|
$6,477.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.06 |
| Max. Negotiated Rate |
$6,218.28 |
| Rate for Payer: Aetna Commercial |
$4,987.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,052.36
|
| Rate for Payer: Cash Price |
$3,238.69
|
| Rate for Payer: Cigna Commercial |
$5,376.23
|
| Rate for Payer: First Health Commercial |
$6,153.51
|
| Rate for Payer: Humana Commercial |
$5,505.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,311.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,780.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,943.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,700.09
|
| Rate for Payer: Ohio Health Group HMO |
$4,858.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,007.99
|
| Rate for Payer: PHCS Commercial |
$6,218.28
|
| Rate for Payer: United Healthcare All Payer |
$5,700.09
|
|
