|
G2 TIBIAL WDGE SZ 7-8 71423056
|
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 7-8 71423060
|
Facility
|
OP
|
$8,834.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,650.36 |
| Max. Negotiated Rate |
$8,481.14 |
| Rate for Payer: Aetna Commercial |
$6,802.58
|
| Rate for Payer: Anthem Medicaid |
$3,038.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,890.93
|
| Rate for Payer: Cash Price |
$4,417.26
|
| Rate for Payer: Cigna Commercial |
$7,332.65
|
| Rate for Payer: First Health Commercial |
$8,392.79
|
| Rate for Payer: Humana Commercial |
$7,509.34
|
| Rate for Payer: Humana KY Medicaid |
$3,038.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,069.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,244.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,519.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,650.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,099.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,774.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,625.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,067.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,686.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,095.82
|
| Rate for Payer: PHCS Commercial |
$8,481.14
|
| Rate for Payer: United Healthcare All Payer |
$7,774.38
|
|
|
G2 TIBIAL WDGE SZ 7-8 71423060
|
Facility
|
IP
|
$8,834.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,650.36 |
| Max. Negotiated Rate |
$8,481.14 |
| Rate for Payer: Aetna Commercial |
$6,802.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,890.93
|
| Rate for Payer: Cash Price |
$4,417.26
|
| Rate for Payer: Cigna Commercial |
$7,332.65
|
| Rate for Payer: First Health Commercial |
$8,392.79
|
| Rate for Payer: Humana Commercial |
$7,509.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,244.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,519.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,650.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,774.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,625.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,067.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,686.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,095.82
|
| Rate for Payer: PHCS Commercial |
$8,481.14
|
| Rate for Payer: United Healthcare All Payer |
$7,774.38
|
|
|
G2 TIBIAL WDGE SZ 7-8 71423064
|
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 7-8 71423064
|
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
|
|
|
G3 LAG SCREW 10.5*90 TI
|
Facility
|
OP
|
$3,676.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.88 |
| Max. Negotiated Rate |
$3,529.20 |
| Rate for Payer: Aetna Commercial |
$2,830.71
|
| Rate for Payer: Anthem Medicaid |
$1,264.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.47
|
| Rate for Payer: Cash Price |
$1,838.12
|
| Rate for Payer: Cigna Commercial |
$3,051.29
|
| Rate for Payer: First Health Commercial |
$3,492.44
|
| Rate for Payer: Humana Commercial |
$3,124.81
|
| Rate for Payer: Humana KY Medicaid |
$1,264.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,713.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,235.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,757.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,941.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.61
|
| Rate for Payer: PHCS Commercial |
$3,529.20
|
| Rate for Payer: United Healthcare All Payer |
$3,235.10
|
|
|
G3 LAG SCREW 10.5*90 TI
|
Facility
|
IP
|
$3,676.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.88 |
| Max. Negotiated Rate |
$3,529.20 |
| Rate for Payer: Aetna Commercial |
$2,830.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.47
|
| Rate for Payer: Cash Price |
$1,838.12
|
| Rate for Payer: Cigna Commercial |
$3,051.29
|
| Rate for Payer: First Health Commercial |
$3,492.44
|
| Rate for Payer: Humana Commercial |
$3,124.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,713.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,235.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,757.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,941.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.61
|
| Rate for Payer: PHCS Commercial |
$3,529.20
|
| Rate for Payer: United Healthcare All Payer |
$3,235.10
|
|
|
G3 L GAMMA KIT 11*300*130 L TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*300*130 L TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*320*130 L TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*320*130 L TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*320*130 R TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*320*130 R TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*340*130 L TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*340*130 L TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*340*130 R TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*340*130 R TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*360*130 L TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*360*130 L TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*360*130 R TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*360*130 R TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*380*130 L TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*380*130 L TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*380*130 R TI
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
G3 L GAMMA KIT 11*380*130 R TI
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
