|
GENESIS II CONETIB WDG 7-8*15M
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II CR ART INSRT SZ 7-8
|
Facility
|
IP
|
$7,342.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.47 |
| Max. Negotiated Rate |
$7,048.38 |
| Rate for Payer: Aetna Commercial |
$5,653.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.81
|
| Rate for Payer: Cash Price |
$3,671.03
|
| Rate for Payer: Cigna Commercial |
$6,093.91
|
| Rate for Payer: First Health Commercial |
$6,974.96
|
| Rate for Payer: Humana Commercial |
$6,240.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,461.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,468.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$954.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,276.04
|
| Rate for Payer: PHCS Commercial |
$7,048.38
|
| Rate for Payer: United Healthcare All Payer |
$6,461.01
|
|
|
GENESIS II CR ART INSRT SZ 7-8
|
Facility
|
OP
|
$7,342.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.47 |
| Max. Negotiated Rate |
$7,048.38 |
| Rate for Payer: Aetna Commercial |
$5,653.39
|
| Rate for Payer: Anthem Medicaid |
$2,524.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.81
|
| Rate for Payer: Cash Price |
$3,671.03
|
| Rate for Payer: Cigna Commercial |
$6,093.91
|
| Rate for Payer: First Health Commercial |
$6,974.96
|
| Rate for Payer: Humana Commercial |
$6,240.75
|
| Rate for Payer: Humana KY Medicaid |
$2,524.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,550.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,575.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,461.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,468.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$954.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,276.04
|
| Rate for Payer: PHCS Commercial |
$7,048.38
|
| Rate for Payer: United Healthcare All Payer |
$6,461.01
|
|
|
GENESIS II CR FEM COMP SZ 8 R
|
Facility
|
IP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
GENESIS II CR FEM COMP SZ 8 R
|
Facility
|
OP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem Medicaid |
$6,142.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Humana KY Medicaid |
$6,142.74
|
| Rate for Payer: Kentucky WC Medicaid |
$6,205.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,265.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
GENESIS II C/R FEM SZ1 LT
|
Facility
|
IP
|
$11,222.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,458.90 |
| Max. Negotiated Rate |
$10,773.44 |
| Rate for Payer: Aetna Commercial |
$8,641.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,753.42
|
| Rate for Payer: Cash Price |
$5,611.16
|
| Rate for Payer: Cigna Commercial |
$9,314.53
|
| Rate for Payer: First Health Commercial |
$10,661.21
|
| Rate for Payer: Humana Commercial |
$9,538.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,202.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,282.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,366.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,875.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,244.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,478.92
|
| Rate for Payer: PHCS Commercial |
$10,773.44
|
| Rate for Payer: United Healthcare All Payer |
$9,875.65
|
|
|
GENESIS II C/R FEM SZ1 LT
|
Facility
|
OP
|
$11,222.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,458.90 |
| Max. Negotiated Rate |
$10,773.44 |
| Rate for Payer: Aetna Commercial |
$8,641.19
|
| Rate for Payer: Anthem Medicaid |
$3,859.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,753.42
|
| Rate for Payer: Cash Price |
$5,611.16
|
| Rate for Payer: Cigna Commercial |
$9,314.53
|
| Rate for Payer: First Health Commercial |
$10,661.21
|
| Rate for Payer: Humana Commercial |
$9,538.98
|
| Rate for Payer: Humana KY Medicaid |
$3,859.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,898.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,202.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,282.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,366.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,936.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,875.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,244.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,478.92
|
| Rate for Payer: PHCS Commercial |
$10,773.44
|
| Rate for Payer: United Healthcare All Payer |
$9,875.65
|
|
|
GENESISII FULLTIB WDG 3-4*10MM
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESISII FULLTIB WDG 3-4*10MM
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II FULLTIB WDG 3-4*5MM
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II FULLTIB WDG 3-4*5MM
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESISII FULLTIB WDG 5-6*10MM
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESISII FULLTIB WDG 5-6*10MM
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II FULLTIB WDG 5-6*5MM
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II FULLTIB WDG 5-6*5MM
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II FULLTIB WDG 7-8*5MM
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II FULLTIB WDG 7-8*5MM
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESISII FULLTIBWDGE 7-8*10MM
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESISII FULLTIBWDGE 7-8*10MM
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
GENESIS II RESRF PATELLA 38MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II RESRF PATELLA 38MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II RESRF PATELLA 41MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II RESRF PATELLA 41MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II SING PEG RES PT29MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
GENESIS II SING PEG RES PT29MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
