|
GENESIS II C/R FEM SZ1 LT
|
Facility
|
IP
|
$11,465.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.72 |
| Max. Negotiated Rate |
$11,007.11 |
| Rate for Payer: Aetna Commercial |
$8,828.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,943.28
|
| Rate for Payer: Cash Price |
$5,732.87
|
| Rate for Payer: Cigna Commercial |
$9,516.56
|
| Rate for Payer: First Health Commercial |
$10,892.45
|
| Rate for Payer: Humana Commercial |
$9,745.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,401.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,461.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,439.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,089.85
|
| Rate for Payer: Ohio Health Group HMO |
$8,599.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,172.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,975.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,911.36
|
| Rate for Payer: PHCS Commercial |
$11,007.11
|
| Rate for Payer: United Healthcare All Payer |
$10,089.85
|
|
|
GENESISII FULLTIB WDG 3-4*10MM
|
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
|
|
|
GENESISII FULLTIB WDG 3-4*10MM
|
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 FULLTIB WDG 3-4*5MM
|
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 FULLTIB WDG 3-4*5MM
|
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
|
|
|
GENESISII FULLTIB WDG 5-6*10MM
|
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
|
|
|
GENESISII FULLTIB WDG 5-6*10MM
|
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 FULLTIB WDG 5-6*5MM
|
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 FULLTIB WDG 5-6*5MM
|
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 FULLTIB WDG 7-8*5MM
|
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 FULLTIB WDG 7-8*5MM
|
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
|
|
|
GENESISII FULLTIBWDGE 7-8*10MM
|
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
|
|
|
GENESISII FULLTIBWDGE 7-8*10MM
|
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 RESRF PATELLA 38MM
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II RESRF PATELLA 38MM
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II RESRF PATELLA 41MM
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II RESRF PATELLA 41MM
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II SING PEG RES PT29MM
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II SING PEG RES PT29MM
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II SING PEG RES PT32MM
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II SING PEG RES PT32MM
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II SING PEG RES PT35MM
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II SING PEG RES PT35MM
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
GENESIS II TIB BASEPLATE SZ2 L
|
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 SZ2 L
|
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
|
|
