GENI II MIS TIB BS CEM SZ-5 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-5 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-6 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-6 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-7 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-7 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-8 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-8 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
|
|
GEN II PS FEMORAL NP SZ 4 RT
|
Facility
|
IP
|
$7,545.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$980.85 |
Max. Negotiated Rate |
$7,243.20 |
Rate for Payer: Aetna Commercial |
$5,809.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
Rate for Payer: Cash Price |
$3,772.50
|
Rate for Payer: Cigna Commercial |
$6,262.35
|
Rate for Payer: First Health Commercial |
$7,167.75
|
Rate for Payer: Humana Commercial |
$6,413.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
Rate for Payer: PHCS Commercial |
$7,243.20
|
Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
GEN II PS FEMORAL NP SZ 4 RT
|
Facility
|
OP
|
$7,545.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$980.85 |
Max. Negotiated Rate |
$7,243.20 |
Rate for Payer: Aetna Commercial |
$5,809.65
|
Rate for Payer: Anthem Medicaid |
$2,594.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
Rate for Payer: Cash Price |
$3,772.50
|
Rate for Payer: Cigna Commercial |
$6,262.35
|
Rate for Payer: First Health Commercial |
$7,167.75
|
Rate for Payer: Humana Commercial |
$6,413.25
|
Rate for Payer: Humana KY Medicaid |
$2,594.73
|
Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
Rate for Payer: PHCS Commercial |
$7,243.20
|
Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
GEN II PS HGH FLXART INSTSZ7-8
|
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
|
|
GEN II PS HGH FLXART INSTSZ7-8
|
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
|
|
GEN II TIBIAL NP SZ 4 LT
|
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
|
|
GEN II TIBIAL NP SZ 4 LT
|
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
|
|
GEN II TIBIAL NP SZ 4 RT
|
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
|
|
GEN II TIBIAL NP SZ 4 RT
|
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
|
|
GEN II TIBIAL NP SZ 5 LT
|
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
|
|
GEN II TIBIAL NP SZ 5 LT
|
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
|
|
GEN II TIBIAL NP SZ 5 RT
|
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
|
|
GEN II TIBIAL NP SZ 5 RT
|
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
|
|
GENISS II L NON PORUS TIB BASE
|
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
|
|
GENISS II L NON PORUS TIB BASE
|
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
|
|
GENISS II RT NONPORUS TIB BASE
|
Facility
|
OP
|
$7,407.21
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$962.94 |
Max. Negotiated Rate |
$7,110.92 |
Rate for Payer: Aetna Commercial |
$5,703.55
|
Rate for Payer: Anthem Medicaid |
$2,547.34
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,777.62
|
Rate for Payer: Cash Price |
$3,703.61
|
Rate for Payer: Cigna Commercial |
$6,147.98
|
Rate for Payer: First Health Commercial |
$7,036.85
|
Rate for Payer: Humana Commercial |
$6,296.13
|
Rate for Payer: Humana KY Medicaid |
$2,547.34
|
Rate for Payer: Kentucky WC Medicaid |
$2,573.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,073.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,466.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.16
|
Rate for Payer: Molina Healthcare Medicaid |
$2,598.45
|
Rate for Payer: Ohio Health Choice Commercial |
$6,518.34
|
Rate for Payer: Ohio Health Group HMO |
$5,555.41
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,481.44
|
Rate for Payer: Ohio Health Group PPO No Differential |
$962.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.24
|
Rate for Payer: PHCS Commercial |
$7,110.92
|
Rate for Payer: United Healthcare All Payer |
$6,518.34
|
|
GENISS II RT NONPORUS TIB BASE
|
Facility
|
IP
|
$7,407.21
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$962.94 |
Max. Negotiated Rate |
$7,110.92 |
Rate for Payer: Aetna Commercial |
$5,703.55
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,777.62
|
Rate for Payer: Cash Price |
$3,703.61
|
Rate for Payer: Cigna Commercial |
$6,147.98
|
Rate for Payer: First Health Commercial |
$7,036.85
|
Rate for Payer: Humana Commercial |
$6,296.13
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,073.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,466.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.16
|
Rate for Payer: Ohio Health Choice Commercial |
$6,518.34
|
Rate for Payer: Ohio Health Group HMO |
$5,555.41
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,481.44
|
Rate for Payer: Ohio Health Group PPO No Differential |
$962.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.24
|
Rate for Payer: PHCS Commercial |
$7,110.92
|
Rate for Payer: United Healthcare All Payer |
$6,518.34
|
|
GENOTROPIN 0.2MG/0.25ML SYR
|
Facility
|
OP
|
$186.36
|
|
Service Code
|
HCPCS J2941
|
Hospital Charge Code |
25002366
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$24.23 |
Max. Negotiated Rate |
$207.82 |
Rate for Payer: Aetna Commercial |
$143.50
|
Rate for Payer: Anthem Medicaid |
$64.09
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$148.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$145.36
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.82
|
Rate for Payer: CareSource Just4Me Medicare |
$200.39
|
Rate for Payer: Cash Price |
$93.18
|
Rate for Payer: Cash Price |
$93.18
|
Rate for Payer: Cigna Commercial |
$154.68
|
Rate for Payer: First Health Commercial |
$177.04
|
Rate for Payer: Humana Commercial |
$158.41
|
Rate for Payer: Humana KY Medicaid |
$64.09
|
Rate for Payer: Humana Medicare Advantage |
$148.44
|
Rate for Payer: Kentucky WC Medicaid |
$64.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$152.82
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.53
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$178.13
|
Rate for Payer: Molina Healthcare Medicaid |
$65.38
|
Rate for Payer: Ohio Health Choice Commercial |
$164.00
|
Rate for Payer: Ohio Health Group HMO |
$139.77
|
Rate for Payer: Ohio Health Group PPO Differential |
$37.27
|
Rate for Payer: Ohio Health Group PPO No Differential |
$24.23
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.77
|
Rate for Payer: PHCS Commercial |
$178.91
|
Rate for Payer: United Healthcare All Payer |
$164.00
|
|