|
GENESIS II TIB BASEPLATE SZ2 R
|
Facility
|
IP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
GENESIS II TIB BASEPLATE SZ2 R
|
Facility
|
OP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem Medicaid |
$3,263.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Humana KY Medicaid |
$3,263.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
GENESIS II TIB BASEPLATE SZ3 L
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
GENESIS II TIB BASEPLATE SZ3 L
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
GENESIS II TIB BASEPLATE SZ3 R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
GENESIS II TIB BASEPLATE SZ3 R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
GENESIS II TIB BASEPLAT SZ 4 R
|
Facility
|
OP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem Medicaid |
$3,176.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Humana KY Medicaid |
$3,176.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,208.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,239.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
GENESIS II TIB BASEPLAT SZ 4 R
|
Facility
|
IP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
GENESIS II TIB BASEPLAT SZ 7 R
|
Facility
|
IP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
GENESIS II TIB BASEPLAT SZ 7 R
|
Facility
|
OP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem Medicaid |
$3,176.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Humana KY Medicaid |
$3,176.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,208.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,239.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
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 |
$1,940.28 |
| 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 |
$2,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,446.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,940.28
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
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 |
$843.60 |
| 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 |
$2,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,446.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,940.28
|
| 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
|
$5,558.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.62 |
| Max. Negotiated Rate |
$5,336.40 |
| Rate for Payer: Aetna Commercial |
$4,280.24
|
| Rate for Payer: Anthem Medicaid |
$1,911.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,335.82
|
| Rate for Payer: Cash Price |
$2,779.38
|
| Rate for Payer: Cigna Commercial |
$4,613.76
|
| Rate for Payer: First Health Commercial |
$5,280.81
|
| Rate for Payer: Humana Commercial |
$4,724.94
|
| Rate for Payer: Humana KY Medicaid |
$1,911.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,931.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,558.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,102.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,950.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,891.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,169.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,447.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,836.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,835.54
|
| Rate for Payer: PHCS Commercial |
$5,336.40
|
| Rate for Payer: United Healthcare All Payer |
$4,891.70
|
|
|
GEN II CONST ART ISRT 3-4*9MM
|
Facility
|
IP
|
$5,558.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.62 |
| Max. Negotiated Rate |
$5,336.40 |
| Rate for Payer: Aetna Commercial |
$4,280.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,335.82
|
| Rate for Payer: Cash Price |
$2,779.38
|
| Rate for Payer: Cigna Commercial |
$4,613.76
|
| Rate for Payer: First Health Commercial |
$5,280.81
|
| Rate for Payer: Humana Commercial |
$4,724.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,558.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,102.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,891.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,169.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,447.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,836.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,835.54
|
| Rate for Payer: PHCS Commercial |
$5,336.40
|
| Rate for Payer: United Healthcare All Payer |
$4,891.70
|
|
|
GEN II CONST ART ISRT 5-6*9MM
|
Facility
|
IP
|
$6,677.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.21 |
| Max. Negotiated Rate |
$6,410.28 |
| Rate for Payer: Aetna Commercial |
$5,141.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,208.36
|
| Rate for Payer: Cash Price |
$3,338.69
|
| Rate for Payer: Cigna Commercial |
$5,542.23
|
| Rate for Payer: First Health Commercial |
$6,343.51
|
| Rate for Payer: Humana Commercial |
$5,675.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,475.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,927.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,876.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,008.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,341.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,809.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,607.39
|
| Rate for Payer: PHCS Commercial |
$6,410.28
|
| Rate for Payer: United Healthcare All Payer |
$5,876.09
|
|
|
GEN II CONST ART ISRT 5-6*9MM
|
Facility
|
OP
|
$6,677.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.21 |
| Max. Negotiated Rate |
$6,410.28 |
| Rate for Payer: Aetna Commercial |
$5,141.58
|
| Rate for Payer: Anthem Medicaid |
$2,296.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,208.36
|
| Rate for Payer: Cash Price |
$3,338.69
|
| Rate for Payer: Cigna Commercial |
$5,542.23
|
| Rate for Payer: First Health Commercial |
$6,343.51
|
| Rate for Payer: Humana Commercial |
$5,675.77
|
| Rate for Payer: Humana KY Medicaid |
$2,296.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,319.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,475.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,927.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,342.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,876.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,008.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,341.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,809.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,607.39
|
| Rate for Payer: PHCS Commercial |
$6,410.28
|
| Rate for Payer: United Healthcare All Payer |
$5,876.09
|
|
|
GENI II MIS TIB BASE CEM SZ5 L
|
Facility
|
IP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BASE CEM SZ5 L
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BASE CEM SZ6 L
|
Facility
|
IP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BASE CEM SZ6 L
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BASE CEM SZ7 L
|
Facility
|
IP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BASE CEM SZ7 L
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BASE CEM SZ 8L
|
Facility
|
IP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BASE CEM SZ 8L
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GENI II MIS TIB BS CEM SZ-1 LF
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
