|
GII HA POR TIBIAL SZ 3 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 3 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 4 LT
|
Facility
|
IP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 4 LT
|
Facility
|
OP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem Medicaid |
$2,938.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Humana KY Medicaid |
$2,938.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 4 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 4 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 5 LT
|
Facility
|
IP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 5 LT
|
Facility
|
OP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem Medicaid |
$2,938.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Humana KY Medicaid |
$2,938.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 5 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 5 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 6 LT
|
Facility
|
IP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 6 LT
|
Facility
|
OP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem Medicaid |
$2,938.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Humana KY Medicaid |
$2,938.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 6 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 6 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 7 LT
|
Facility
|
OP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem Medicaid |
$2,938.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Humana KY Medicaid |
$2,938.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 7 LT
|
Facility
|
IP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 7 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 7 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 8 LT
|
Facility
|
OP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem Medicaid |
$2,938.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Humana KY Medicaid |
$2,938.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 8 LT
|
Facility
|
IP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 8 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 8 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII PAT W/FLEX LOK PEG 23MM
|
Facility
|
OP
|
$3,811.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.53 |
| Max. Negotiated Rate |
$3,659.28 |
| Rate for Payer: Aetna Commercial |
$2,935.05
|
| Rate for Payer: Anthem Medicaid |
$1,310.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,973.16
|
| Rate for Payer: Cash Price |
$1,905.88
|
| Rate for Payer: Cigna Commercial |
$3,163.75
|
| Rate for Payer: First Health Commercial |
$3,621.16
|
| Rate for Payer: Humana Commercial |
$3,239.99
|
| Rate for Payer: Humana KY Medicaid |
$1,310.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,324.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,125.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,813.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,337.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,354.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,858.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.64
|
| Rate for Payer: PHCS Commercial |
$3,659.28
|
| Rate for Payer: United Healthcare All Payer |
$3,354.34
|
|
|
GII PAT W/FLEX LOK PEG 23MM
|
Facility
|
IP
|
$3,811.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.53 |
| Max. Negotiated Rate |
$3,659.28 |
| Rate for Payer: Aetna Commercial |
$2,935.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,973.16
|
| Rate for Payer: Cash Price |
$1,905.88
|
| Rate for Payer: Cigna Commercial |
$3,163.75
|
| Rate for Payer: First Health Commercial |
$3,621.16
|
| Rate for Payer: Humana Commercial |
$3,239.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,125.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,813.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,354.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,858.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.64
|
| Rate for Payer: PHCS Commercial |
$3,659.28
|
| Rate for Payer: United Healthcare All Payer |
$3,354.34
|
|
|
G II PAT W/ FLEX LOK PEG 26MM
|
Facility
|
OP
|
$3,811.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.53 |
| Max. Negotiated Rate |
$3,659.28 |
| Rate for Payer: Aetna Commercial |
$2,935.05
|
| Rate for Payer: Anthem Medicaid |
$1,310.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,973.16
|
| Rate for Payer: Cash Price |
$1,905.88
|
| Rate for Payer: Cigna Commercial |
$3,163.75
|
| Rate for Payer: First Health Commercial |
$3,621.16
|
| Rate for Payer: Humana Commercial |
$3,239.99
|
| Rate for Payer: Humana KY Medicaid |
$1,310.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,324.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,125.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,813.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,337.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,354.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,858.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.64
|
| Rate for Payer: PHCS Commercial |
$3,659.28
|
| Rate for Payer: United Healthcare All Payer |
$3,354.34
|
|
