|
G2 CONST INSERT SZ 5-6 21MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 5-6 21MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 5-6 25MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 5-6 25MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 5-6 30MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 5-6 30MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 11MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 7-8 11MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 7-8 13MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 7-8 13MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 7-8 15MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 15MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 18MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 18MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 21MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 21MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 25MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 25MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 30MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 7-8 30MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 HIGH FLX ART INSERT SZ 3-4
|
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
|
|
|
G2 HIGH FLX ART INSERT SZ 3-4
|
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
|
|
|
G2L NON POR TIB BASE PLATE
|
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
|
|
|
G2L NON POR TIB BASE PLATE
|
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
|
|
|
G2 NP TIBIAL BASEPLATE SZ 2 L
|
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
|
|
