|
G2 PAT RESURFACING 35MM
|
Facility
|
OP
|
$4,669.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,400.72 |
| Max. Negotiated Rate |
$4,482.30 |
| Rate for Payer: Aetna Commercial |
$3,595.18
|
| Rate for Payer: Anthem Medicaid |
$1,605.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,641.87
|
| Rate for Payer: Cash Price |
$2,334.53
|
| Rate for Payer: Cigna Commercial |
$3,875.32
|
| Rate for Payer: First Health Commercial |
$4,435.61
|
| Rate for Payer: Humana Commercial |
$3,968.70
|
| Rate for Payer: Humana KY Medicaid |
$1,605.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,622.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,828.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,445.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,108.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,501.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,735.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,062.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,221.65
|
| Rate for Payer: PHCS Commercial |
$4,482.30
|
| Rate for Payer: United Healthcare All Payer |
$4,108.77
|
|
|
G2 PAT RESURFACING 35MM
|
Facility
|
IP
|
$4,669.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,400.72 |
| Max. Negotiated Rate |
$4,482.30 |
| Rate for Payer: Aetna Commercial |
$3,595.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,641.87
|
| Rate for Payer: Cash Price |
$2,334.53
|
| Rate for Payer: Cigna Commercial |
$3,875.32
|
| Rate for Payer: First Health Commercial |
$4,435.61
|
| Rate for Payer: Humana Commercial |
$3,968.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,828.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,445.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,108.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,501.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,735.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,062.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,221.65
|
| Rate for Payer: PHCS Commercial |
$4,482.30
|
| Rate for Payer: United Healthcare All Payer |
$4,108.77
|
|
|
G2 POST ART INSERT SZ 7-8 15MM
|
Facility
|
IP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
G2 POST ART INSERT SZ 7-8 15MM
|
Facility
|
OP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem Medicaid |
$1,636.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Humana KY Medicaid |
$1,636.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
G2 PS HI FLEX ISRT SZ5-6*21
|
Facility
|
IP
|
$4,920.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,476.09 |
| Max. Negotiated Rate |
$4,723.50 |
| Rate for Payer: Aetna Commercial |
$3,788.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.84
|
| Rate for Payer: Cash Price |
$2,460.16
|
| Rate for Payer: Cigna Commercial |
$4,083.86
|
| Rate for Payer: First Health Commercial |
$4,674.29
|
| Rate for Payer: Humana Commercial |
$4,182.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,034.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,476.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,329.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,690.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,936.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,280.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.01
|
| Rate for Payer: PHCS Commercial |
$4,723.50
|
| Rate for Payer: United Healthcare All Payer |
$4,329.87
|
|
|
G2 PS HI FLEX ISRT SZ5-6*21
|
Facility
|
OP
|
$4,920.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,476.09 |
| Max. Negotiated Rate |
$4,723.50 |
| Rate for Payer: Aetna Commercial |
$3,788.64
|
| Rate for Payer: Anthem Medicaid |
$1,692.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.84
|
| Rate for Payer: Cash Price |
$2,460.16
|
| Rate for Payer: Cigna Commercial |
$4,083.86
|
| Rate for Payer: First Health Commercial |
$4,674.29
|
| Rate for Payer: Humana Commercial |
$4,182.26
|
| Rate for Payer: Humana KY Medicaid |
$1,692.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,709.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,034.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,476.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,726.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,329.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,690.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,936.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,280.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.01
|
| Rate for Payer: PHCS Commercial |
$4,723.50
|
| Rate for Payer: United Healthcare All Payer |
$4,329.87
|
|
|
G2 TIBIAL FIN FIX 1-2
|
Facility
|
IP
|
$2,157.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.13 |
| Max. Negotiated Rate |
$2,070.81 |
| Rate for Payer: Aetna Commercial |
$1,660.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,682.53
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cigna Commercial |
$1,790.38
|
| Rate for Payer: First Health Commercial |
$2,049.24
|
| Rate for Payer: Humana Commercial |
$1,833.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,898.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,725.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,876.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.39
|
| Rate for Payer: PHCS Commercial |
$2,070.81
|
| Rate for Payer: United Healthcare All Payer |
$1,898.24
|
|
|
G2 TIBIAL FIN FIX 1-2
|
Facility
|
OP
|
$2,157.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.13 |
| Max. Negotiated Rate |
$2,070.81 |
| Rate for Payer: Aetna Commercial |
$1,660.96
|
| Rate for Payer: Anthem Medicaid |
$741.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,682.53
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cigna Commercial |
$1,790.38
|
| Rate for Payer: First Health Commercial |
$2,049.24
|
| Rate for Payer: Humana Commercial |
$1,833.53
|
| Rate for Payer: Humana KY Medicaid |
$741.82
|
| Rate for Payer: Kentucky WC Medicaid |
$749.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$756.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,898.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,725.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,876.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.39
|
| Rate for Payer: PHCS Commercial |
$2,070.81
|
| Rate for Payer: United Healthcare All Payer |
$1,898.24
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421141
|
Facility
|
OP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem Medicaid |
$3,816.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Humana KY Medicaid |
$3,816.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,855.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,892.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421141
|
Facility
|
IP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421145
|
Facility
|
IP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421145
|
Facility
|
OP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem Medicaid |
$3,816.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Humana KY Medicaid |
$3,816.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,855.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,892.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423017
|
Facility
|
IP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423017
|
Facility
|
OP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem Medicaid |
$2,445.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Humana KY Medicaid |
$2,445.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423018
|
Facility
|
IP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423018
|
Facility
|
OP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem Medicaid |
$2,445.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Humana KY Medicaid |
$2,445.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423021
|
Facility
|
IP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423021
|
Facility
|
OP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem Medicaid |
$2,445.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Humana KY Medicaid |
$2,445.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423025
|
Facility
|
OP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem Medicaid |
$2,445.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Humana KY Medicaid |
$2,445.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423025
|
Facility
|
IP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423029
|
Facility
|
IP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423029
|
Facility
|
OP
|
$7,110.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.24 |
| Max. Negotiated Rate |
$6,826.38 |
| Rate for Payer: Aetna Commercial |
$5,475.32
|
| Rate for Payer: Anthem Medicaid |
$2,445.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.43
|
| Rate for Payer: Cash Price |
$3,555.41
|
| Rate for Payer: Cigna Commercial |
$5,901.97
|
| Rate for Payer: First Health Commercial |
$6,755.27
|
| Rate for Payer: Humana Commercial |
$6,044.19
|
| Rate for Payer: Humana KY Medicaid |
$2,445.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,186.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.46
|
| Rate for Payer: PHCS Commercial |
$6,826.38
|
| Rate for Payer: United Healthcare All Payer |
$6,257.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423033
|
Facility
|
OP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem Medicaid |
$2,685.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Humana KY Medicaid |
$2,685.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,712.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423033
|
Facility
|
IP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423037
|
Facility
|
OP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem Medicaid |
$2,685.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Humana KY Medicaid |
$2,685.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,712.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
