|
GEN II CONST ART ISRT 5-6*9MM
|
Facility
|
OP
|
$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 Medicaid |
$2,227.57
|
| 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: Humana KY Medicaid |
$2,227.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,250.24
|
| 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: Molina Healthcare Medicaid |
$2,272.26
|
| 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
|
|
|
GENI II MIS TIB BASE CEM SZ5 L
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BASE CEM SZ5 L
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BASE CEM SZ6 L
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BASE CEM SZ6 L
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BASE CEM SZ7 L
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BASE CEM SZ7 L
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BASE CEM SZ 8L
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BASE CEM SZ 8L
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-1 LF
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-1 LF
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-1 RT
|
Facility
|
IP
|
$7,627.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.53 |
| Max. Negotiated Rate |
$7,322.04 |
| Rate for Payer: Aetna Commercial |
$5,872.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,949.15
|
| Rate for Payer: Cash Price |
$3,813.56
|
| Rate for Payer: Cigna Commercial |
$6,330.51
|
| Rate for Payer: First Health Commercial |
$7,245.76
|
| Rate for Payer: Humana Commercial |
$6,483.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,254.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,720.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.41
|
| Rate for Payer: PHCS Commercial |
$7,322.04
|
| Rate for Payer: United Healthcare All Payer |
$6,711.87
|
|
|
GENI II MIS TIB BS CEM SZ-1 RT
|
Facility
|
OP
|
$7,627.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.53 |
| Max. Negotiated Rate |
$7,322.04 |
| Rate for Payer: Aetna Commercial |
$5,872.88
|
| Rate for Payer: Anthem Medicaid |
$2,622.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,949.15
|
| Rate for Payer: Cash Price |
$3,813.56
|
| Rate for Payer: Cigna Commercial |
$6,330.51
|
| Rate for Payer: First Health Commercial |
$7,245.76
|
| Rate for Payer: Humana Commercial |
$6,483.05
|
| Rate for Payer: Humana KY Medicaid |
$2,622.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,649.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,254.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,720.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.41
|
| Rate for Payer: PHCS Commercial |
$7,322.04
|
| Rate for Payer: United Healthcare All Payer |
$6,711.87
|
|
|
GENI II MIS TIB BS CEM SZ-2 LF
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-2 LF
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-2 RT
|
Facility
|
OP
|
$7,627.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.53 |
| Max. Negotiated Rate |
$7,322.04 |
| Rate for Payer: Aetna Commercial |
$5,872.88
|
| Rate for Payer: Anthem Medicaid |
$2,622.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,949.15
|
| Rate for Payer: Cash Price |
$3,813.56
|
| Rate for Payer: Cigna Commercial |
$6,330.51
|
| Rate for Payer: First Health Commercial |
$7,245.76
|
| Rate for Payer: Humana Commercial |
$6,483.05
|
| Rate for Payer: Humana KY Medicaid |
$2,622.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,649.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,254.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,720.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.41
|
| Rate for Payer: PHCS Commercial |
$7,322.04
|
| Rate for Payer: United Healthcare All Payer |
$6,711.87
|
|
|
GENI II MIS TIB BS CEM SZ-2 RT
|
Facility
|
IP
|
$7,627.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.53 |
| Max. Negotiated Rate |
$7,322.04 |
| Rate for Payer: Aetna Commercial |
$5,872.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,949.15
|
| Rate for Payer: Cash Price |
$3,813.56
|
| Rate for Payer: Cigna Commercial |
$6,330.51
|
| Rate for Payer: First Health Commercial |
$7,245.76
|
| Rate for Payer: Humana Commercial |
$6,483.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,254.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,720.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.41
|
| Rate for Payer: PHCS Commercial |
$7,322.04
|
| Rate for Payer: United Healthcare All Payer |
$6,711.87
|
|
|
GENI II MIS TIB BS CEM SZ-3 LF
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-3 LF
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-3 RT
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-3 RT
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-4 LF
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-4 LF
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-4 RT
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GENI II MIS TIB BS CEM SZ-4 RT
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
