|
GMRS TIBIAL SLEEVE ALL SIZES
|
Facility
|
OP
|
$4,294.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.28 |
| Max. Negotiated Rate |
$4,122.48 |
| Rate for Payer: Aetna Commercial |
$3,306.57
|
| Rate for Payer: Anthem Medicaid |
$1,476.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,349.51
|
| Rate for Payer: Cash Price |
$2,147.12
|
| Rate for Payer: Cigna Commercial |
$3,564.23
|
| Rate for Payer: First Health Commercial |
$4,079.54
|
| Rate for Payer: Humana Commercial |
$3,650.11
|
| Rate for Payer: Humana KY Medicaid |
$1,476.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,491.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,506.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,778.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,220.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,435.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,963.03
|
| Rate for Payer: PHCS Commercial |
$4,122.48
|
| Rate for Payer: United Healthcare All Payer |
$3,778.94
|
|
|
GMRS TIBIAL SLEEVE ALL SIZES
|
Facility
|
IP
|
$4,294.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.28 |
| Max. Negotiated Rate |
$4,122.48 |
| Rate for Payer: Aetna Commercial |
$3,306.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,349.51
|
| Rate for Payer: Cash Price |
$2,147.12
|
| Rate for Payer: Cigna Commercial |
$3,564.23
|
| Rate for Payer: First Health Commercial |
$4,079.54
|
| Rate for Payer: Humana Commercial |
$3,650.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,778.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,220.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,435.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,963.03
|
| Rate for Payer: PHCS Commercial |
$4,122.48
|
| Rate for Payer: United Healthcare All Payer |
$3,778.94
|
|
|
GMRS TIB ROTATING COMP ALL SIZ
|
Facility
|
IP
|
$17,422.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,226.76 |
| Max. Negotiated Rate |
$16,725.62 |
| Rate for Payer: Aetna Commercial |
$13,415.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,589.57
|
| Rate for Payer: Cash Price |
$8,711.26
|
| Rate for Payer: Cigna Commercial |
$14,460.69
|
| Rate for Payer: First Health Commercial |
$16,551.39
|
| Rate for Payer: Humana Commercial |
$14,809.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,286.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,226.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,331.82
|
| Rate for Payer: Ohio Health Group HMO |
$13,066.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,938.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,157.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,021.54
|
| Rate for Payer: PHCS Commercial |
$16,725.62
|
| Rate for Payer: United Healthcare All Payer |
$15,331.82
|
|
|
GMRS TIB ROTATING COMP ALL SIZ
|
Facility
|
OP
|
$17,422.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,226.76 |
| Max. Negotiated Rate |
$16,725.62 |
| Rate for Payer: Aetna Commercial |
$13,415.34
|
| Rate for Payer: Anthem Medicaid |
$5,991.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,589.57
|
| Rate for Payer: Cash Price |
$8,711.26
|
| Rate for Payer: Cigna Commercial |
$14,460.69
|
| Rate for Payer: First Health Commercial |
$16,551.39
|
| Rate for Payer: Humana Commercial |
$14,809.14
|
| Rate for Payer: Humana KY Medicaid |
$5,991.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,052.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,286.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,226.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,111.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,331.82
|
| Rate for Payer: Ohio Health Group HMO |
$13,066.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,938.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,157.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,021.54
|
| Rate for Payer: PHCS Commercial |
$16,725.62
|
| Rate for Payer: United Healthcare All Payer |
$15,331.82
|
|
|
GNS II ARTICULAR INSRT SZ3-4
|
Facility
|
IP
|
$5,090.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$4,886.40 |
| Rate for Payer: Aetna Commercial |
$3,919.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,545.00
|
| Rate for Payer: Cigna Commercial |
$4,224.70
|
| Rate for Payer: First Health Commercial |
$4,835.50
|
| Rate for Payer: Humana Commercial |
$4,326.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.10
|
| Rate for Payer: PHCS Commercial |
$4,886.40
|
| Rate for Payer: United Healthcare All Payer |
$4,479.20
|
|
|
GNS II ARTICULAR INSRT SZ3-4
|
Facility
|
OP
|
$5,090.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$4,886.40 |
| Rate for Payer: Aetna Commercial |
$3,919.30
|
| Rate for Payer: Anthem Medicaid |
$1,750.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,545.00
|
| Rate for Payer: Cigna Commercial |
$4,224.70
|
| Rate for Payer: First Health Commercial |
$4,835.50
|
| Rate for Payer: Humana Commercial |
$4,326.50
|
| Rate for Payer: Humana KY Medicaid |
$1,750.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,768.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,785.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.10
|
| Rate for Payer: PHCS Commercial |
$4,886.40
|
| Rate for Payer: United Healthcare All Payer |
$4,479.20
|
|
|
GNS II CEM TIB SZ 8 RIGHT
|
Facility
|
IP
|
$7,607.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.16 |
| Max. Negotiated Rate |
$7,302.92 |
| Rate for Payer: Aetna Commercial |
$5,857.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,933.62
|
| Rate for Payer: Cash Price |
$3,803.61
|
| Rate for Payer: Cigna Commercial |
$6,313.98
|
| Rate for Payer: First Health Commercial |
$7,226.85
|
| Rate for Payer: Humana Commercial |
$6,466.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,237.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,614.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,694.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,705.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,085.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,618.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.97
|
| Rate for Payer: PHCS Commercial |
$7,302.92
|
| Rate for Payer: United Healthcare All Payer |
$6,694.34
|
|
|
GNS II CEM TIB SZ 8 RIGHT
|
Facility
|
OP
|
$7,607.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.16 |
| Max. Negotiated Rate |
$7,302.92 |
| Rate for Payer: Aetna Commercial |
$5,857.55
|
| Rate for Payer: Anthem Medicaid |
$2,616.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,933.62
|
| Rate for Payer: Cash Price |
$3,803.61
|
| Rate for Payer: Cigna Commercial |
$6,313.98
|
| Rate for Payer: First Health Commercial |
$7,226.85
|
| Rate for Payer: Humana Commercial |
$6,466.13
|
| Rate for Payer: Humana KY Medicaid |
$2,616.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,642.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,237.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,614.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,668.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,694.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,705.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,085.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,618.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.97
|
| Rate for Payer: PHCS Commercial |
$7,302.92
|
| Rate for Payer: United Healthcare All Payer |
$6,694.34
|
|
|
GNS II CMT TIB SZ3 RT
|
Facility
|
OP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem Medicaid |
$3,176.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Humana KY Medicaid |
$3,176.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,208.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,239.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
GNS II CMT TIB SZ3 RT
|
Facility
|
IP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
GNS II CMT TIB SZ5 LEFT
|
Facility
|
IP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
GNS II CMT TIB SZ5 LEFT
|
Facility
|
OP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem Medicaid |
$3,176.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Humana KY Medicaid |
$3,176.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,208.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,239.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
GNS II CMT TIB SZ 8 LT
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GNS II CMT TIB SZ 8 LT
|
Facility
|
IP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
GNS II LONG STEM 10*70
|
Facility
|
IP
|
$9,844.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,953.40 |
| Max. Negotiated Rate |
$9,450.87 |
| Rate for Payer: Aetna Commercial |
$7,580.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,678.83
|
| Rate for Payer: Cash Price |
$4,922.33
|
| Rate for Payer: Cigna Commercial |
$8,171.07
|
| Rate for Payer: First Health Commercial |
$9,352.43
|
| Rate for Payer: Humana Commercial |
$8,367.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,072.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,265.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,953.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,663.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,383.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,875.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,564.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,792.82
|
| Rate for Payer: PHCS Commercial |
$9,450.87
|
| Rate for Payer: United Healthcare All Payer |
$8,663.30
|
|
|
GNS II LONG STEM 10*70
|
Facility
|
OP
|
$9,844.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,953.40 |
| Max. Negotiated Rate |
$9,450.87 |
| Rate for Payer: Aetna Commercial |
$7,580.39
|
| Rate for Payer: Anthem Medicaid |
$3,385.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,678.83
|
| Rate for Payer: Cash Price |
$4,922.33
|
| Rate for Payer: Cigna Commercial |
$8,171.07
|
| Rate for Payer: First Health Commercial |
$9,352.43
|
| Rate for Payer: Humana Commercial |
$8,367.96
|
| Rate for Payer: Humana KY Medicaid |
$3,385.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,420.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,072.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,265.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,953.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,453.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,663.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,383.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,875.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,564.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,792.82
|
| Rate for Payer: PHCS Commercial |
$9,450.87
|
| Rate for Payer: United Healthcare All Payer |
$8,663.30
|
|
|
GNS II POROUS P/S FEM SZ 1 LT
|
Facility
|
OP
|
$12,537.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,761.21 |
| Max. Negotiated Rate |
$12,035.88 |
| Rate for Payer: Aetna Commercial |
$9,653.78
|
| Rate for Payer: Anthem Medicaid |
$4,311.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,779.16
|
| Rate for Payer: Cash Price |
$6,268.69
|
| Rate for Payer: Cigna Commercial |
$10,406.03
|
| Rate for Payer: First Health Commercial |
$11,910.51
|
| Rate for Payer: Humana Commercial |
$10,656.77
|
| Rate for Payer: Humana KY Medicaid |
$4,311.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,355.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,280.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,252.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,761.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,398.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,032.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,403.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,029.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,907.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,650.79
|
| Rate for Payer: PHCS Commercial |
$12,035.88
|
| Rate for Payer: United Healthcare All Payer |
$11,032.89
|
|
|
GNS II POROUS P/S FEM SZ 1 LT
|
Facility
|
IP
|
$12,537.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,761.21 |
| Max. Negotiated Rate |
$12,035.88 |
| Rate for Payer: Aetna Commercial |
$9,653.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,779.16
|
| Rate for Payer: Cash Price |
$6,268.69
|
| Rate for Payer: Cigna Commercial |
$10,406.03
|
| Rate for Payer: First Health Commercial |
$11,910.51
|
| Rate for Payer: Humana Commercial |
$10,656.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,280.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,252.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,761.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,032.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,403.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,029.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,907.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,650.79
|
| Rate for Payer: PHCS Commercial |
$12,035.88
|
| Rate for Payer: United Healthcare All Payer |
$11,032.89
|
|
|
GNS II POROUS P/S FEM SZ 4 RT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
GNS II POROUS P/S FEM SZ 4 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
GNS II POROUS P/S FEM SZ 5 RT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
GNS II POROUS P/S FEM SZ 5 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
GNS II POROUS P/S FEM SZ 6 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
GNS II POROUS P/S FEM SZ 6 RT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
GNS II POROUS P/S FEM SZ 7 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
