|
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
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423049
|
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 TIBIAL WDGE SZ 1-2 71423049
|
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 TIBIAL WDGE SZ 1-2 71423053
|
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 TIBIAL WDGE SZ 1-2 71423053
|
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 TIBIAL WDGE SZ 1-2 71423057
|
Facility
|
OP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem Medicaid |
$2,962.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Humana KY Medicaid |
$2,962.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,993.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423057
|
Facility
|
IP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423061
|
Facility
|
IP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423061
|
Facility
|
OP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem Medicaid |
$2,962.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Humana KY Medicaid |
$2,962.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,993.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423022
|
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 3-4 71423022
|
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 3-4 71423026
|
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 3-4 71423026
|
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 3-4 71423030
|
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 3-4 71423030
|
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 3-4 71423050
|
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 TIBIAL WDGE SZ 3-4 71423050
|
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 TIBIAL WDGE SZ 3-4 71423054
|
Facility
|
OP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem Medicaid |
$2,962.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Humana KY Medicaid |
$2,962.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,993.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423054
|
Facility
|
IP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423058
|
Facility
|
IP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423058
|
Facility
|
OP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem Medicaid |
$2,962.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Humana KY Medicaid |
$2,962.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,993.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423062
|
Facility
|
IP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423062
|
Facility
|
OP
|
$8,615.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.66 |
| Max. Negotiated Rate |
$8,270.90 |
| Rate for Payer: Aetna Commercial |
$6,633.95
|
| Rate for Payer: Anthem Medicaid |
$2,962.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.11
|
| Rate for Payer: Cash Price |
$4,307.76
|
| Rate for Payer: Cigna Commercial |
$7,150.88
|
| Rate for Payer: First Health Commercial |
$8,184.74
|
| Rate for Payer: Humana Commercial |
$7,323.19
|
| Rate for Payer: Humana KY Medicaid |
$2,962.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,993.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.71
|
| Rate for Payer: PHCS Commercial |
$8,270.90
|
| Rate for Payer: United Healthcare All Payer |
$7,581.66
|
|
|
G2 TIBIAL WDGE SZ 5-6 71423019
|
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 5-6 71423019
|
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
|
|
