|
GNS II ARTICULAR INSRT SZ3-4
|
Facility
|
IP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
GNS II CEM TIB SZ 8 RIGHT
|
Facility
|
OP
|
$7,407.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.94 |
| Max. Negotiated Rate |
$7,110.92 |
| Rate for Payer: Aetna Commercial |
$5,703.55
|
| Rate for Payer: Anthem Medicaid |
$2,547.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,777.62
|
| Rate for Payer: Cash Price |
$3,703.61
|
| Rate for Payer: Cigna Commercial |
$6,147.98
|
| Rate for Payer: First Health Commercial |
$7,036.85
|
| Rate for Payer: Humana Commercial |
$6,296.13
|
| Rate for Payer: Humana KY Medicaid |
$2,547.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,573.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,073.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,466.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,598.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,518.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,555.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,481.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$962.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.24
|
| Rate for Payer: PHCS Commercial |
$7,110.92
|
| Rate for Payer: United Healthcare All Payer |
$6,518.34
|
|
|
GNS II CEM TIB SZ 8 RIGHT
|
Facility
|
IP
|
$7,407.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.94 |
| Max. Negotiated Rate |
$7,110.92 |
| Rate for Payer: Aetna Commercial |
$5,703.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,777.62
|
| Rate for Payer: Cash Price |
$3,703.61
|
| Rate for Payer: Cigna Commercial |
$6,147.98
|
| Rate for Payer: First Health Commercial |
$7,036.85
|
| Rate for Payer: Humana Commercial |
$6,296.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,073.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,466.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,518.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,555.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,481.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$962.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,296.24
|
| Rate for Payer: PHCS Commercial |
$7,110.92
|
| Rate for Payer: United Healthcare All Payer |
$6,518.34
|
|
|
GNS II CMT TIB SZ3 RT
|
Facility
|
IP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GNS II CMT TIB SZ3 RT
|
Facility
|
OP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem Medicaid |
$3,107.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Humana KY Medicaid |
$3,107.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,169.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GNS II CMT TIB SZ5 LEFT
|
Facility
|
IP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GNS II CMT TIB SZ5 LEFT
|
Facility
|
OP
|
$9,035.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.64 |
| Max. Negotiated Rate |
$8,674.23 |
| Rate for Payer: Aetna Commercial |
$6,957.46
|
| Rate for Payer: Anthem Medicaid |
$3,107.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,047.81
|
| Rate for Payer: Cash Price |
$4,517.83
|
| Rate for Payer: Cigna Commercial |
$7,499.60
|
| Rate for Payer: First Health Commercial |
$8,583.88
|
| Rate for Payer: Humana Commercial |
$7,680.31
|
| Rate for Payer: Humana KY Medicaid |
$3,107.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,409.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,668.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,710.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,169.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,951.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.05
|
| Rate for Payer: PHCS Commercial |
$8,674.23
|
| Rate for Payer: United Healthcare All Payer |
$7,951.38
|
|
|
GNS II CMT TIB SZ 8 LT
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GNS II CMT TIB SZ 8 LT
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GNS II LONG STEM 10*70
|
Facility
|
OP
|
$9,644.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.81 |
| Max. Negotiated Rate |
$9,258.87 |
| Rate for Payer: Aetna Commercial |
$7,426.39
|
| Rate for Payer: Anthem Medicaid |
$3,316.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,522.83
|
| Rate for Payer: Cash Price |
$4,822.33
|
| Rate for Payer: Cigna Commercial |
$8,005.07
|
| Rate for Payer: First Health Commercial |
$9,162.43
|
| Rate for Payer: Humana Commercial |
$8,197.96
|
| Rate for Payer: Humana KY Medicaid |
$3,316.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,908.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,117.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,487.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,233.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,928.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.84
|
| Rate for Payer: PHCS Commercial |
$9,258.87
|
| Rate for Payer: United Healthcare All Payer |
$8,487.30
|
|
|
GNS II LONG STEM 10*70
|
Facility
|
IP
|
$9,644.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.81 |
| Max. Negotiated Rate |
$9,258.87 |
| Rate for Payer: Aetna Commercial |
$7,426.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,522.83
|
| Rate for Payer: Cash Price |
$4,822.33
|
| Rate for Payer: Cigna Commercial |
$8,005.07
|
| Rate for Payer: First Health Commercial |
$9,162.43
|
| Rate for Payer: Humana Commercial |
$8,197.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,908.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,117.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,487.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,233.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,928.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.84
|
| Rate for Payer: PHCS Commercial |
$9,258.87
|
| Rate for Payer: United Healthcare All Payer |
$8,487.30
|
|
|
GNS II POROUS P/S FEM SZ 1 LT
|
Facility
|
IP
|
$12,288.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.46 |
| Max. Negotiated Rate |
$11,796.60 |
| Rate for Payer: Aetna Commercial |
$9,461.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,584.73
|
| Rate for Payer: Cash Price |
$6,144.06
|
| Rate for Payer: Cigna Commercial |
$10,199.14
|
| Rate for Payer: First Health Commercial |
$11,673.71
|
| Rate for Payer: Humana Commercial |
$10,444.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,076.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,068.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,686.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,813.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,216.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,457.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,809.32
|
| Rate for Payer: PHCS Commercial |
$11,796.60
|
| Rate for Payer: United Healthcare All Payer |
$10,813.55
|
|
|
GNS II POROUS P/S FEM SZ 1 LT
|
Facility
|
OP
|
$12,288.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.46 |
| Max. Negotiated Rate |
$11,796.60 |
| Rate for Payer: Aetna Commercial |
$9,461.85
|
| Rate for Payer: Anthem Medicaid |
$4,225.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,584.73
|
| Rate for Payer: Cash Price |
$6,144.06
|
| Rate for Payer: Cigna Commercial |
$10,199.14
|
| Rate for Payer: First Health Commercial |
$11,673.71
|
| Rate for Payer: Humana Commercial |
$10,444.90
|
| Rate for Payer: Humana KY Medicaid |
$4,225.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,268.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,076.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,068.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,686.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,310.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,813.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,216.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,457.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,809.32
|
| Rate for Payer: PHCS Commercial |
$11,796.60
|
| Rate for Payer: United Healthcare All Payer |
$10,813.55
|
|
|
GNS II POROUS P/S FEM SZ 4 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 4 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
|
|
GNS II POROUS P/S FEM SZ 5 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 5 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 6 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 6 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 7 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 7 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 8 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POROUS P/S FEM SZ 8 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
GNS II POR TIB SZ 1 LEFT
|
Facility
|
OP
|
$9,258.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.63 |
| Max. Negotiated Rate |
$8,888.32 |
| Rate for Payer: Aetna Commercial |
$7,129.18
|
| Rate for Payer: Anthem Medicaid |
$3,184.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,221.76
|
| Rate for Payer: Cash Price |
$4,629.34
|
| Rate for Payer: Cigna Commercial |
$7,684.70
|
| Rate for Payer: First Health Commercial |
$8,795.74
|
| Rate for Payer: Humana Commercial |
$7,869.87
|
| Rate for Payer: Humana KY Medicaid |
$3,184.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,216.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,832.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,247.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,851.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,203.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,870.19
|
| Rate for Payer: PHCS Commercial |
$8,888.32
|
| Rate for Payer: United Healthcare All Payer |
$8,147.63
|
|
|
GNS II POR TIB SZ 1 LEFT
|
Facility
|
IP
|
$9,258.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.63 |
| Max. Negotiated Rate |
$8,888.32 |
| Rate for Payer: Aetna Commercial |
$7,129.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,221.76
|
| Rate for Payer: Cash Price |
$4,629.34
|
| Rate for Payer: Cigna Commercial |
$7,684.70
|
| Rate for Payer: First Health Commercial |
$8,795.74
|
| Rate for Payer: Humana Commercial |
$7,869.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,592.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,832.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,147.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,944.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,851.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,203.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,870.19
|
| Rate for Payer: PHCS Commercial |
$8,888.32
|
| Rate for Payer: United Healthcare All Payer |
$8,147.63
|
|
