|
HII SS CONNECTING ROD 8*350MM
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.80 |
| Max. Negotiated Rate |
$1,061.76 |
| Rate for Payer: Aetna Commercial |
$851.62
|
| Rate for Payer: Anthem Medicaid |
$380.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$862.68
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$917.98
|
| Rate for Payer: First Health Commercial |
$1,050.70
|
| Rate for Payer: Humana Commercial |
$940.10
|
| Rate for Payer: Humana KY Medicaid |
$380.35
|
| Rate for Payer: Kentucky WC Medicaid |
$384.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$906.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$816.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$973.28
|
| Rate for Payer: Ohio Health Group HMO |
$829.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$884.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$962.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.14
|
| Rate for Payer: PHCS Commercial |
$1,061.76
|
| Rate for Payer: United Healthcare All Payer |
$973.28
|
|
|
HII SS CONNECTING ROD 8*350MM
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.80 |
| Max. Negotiated Rate |
$1,061.76 |
| Rate for Payer: Aetna Commercial |
$851.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$862.68
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$917.98
|
| Rate for Payer: First Health Commercial |
$1,050.70
|
| Rate for Payer: Humana Commercial |
$940.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$906.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$816.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$973.28
|
| Rate for Payer: Ohio Health Group HMO |
$829.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$884.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$962.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.14
|
| Rate for Payer: PHCS Commercial |
$1,061.76
|
| Rate for Payer: United Healthcare All Payer |
$973.28
|
|
|
HII SS CONNECTING ROD 8*400MM
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
HII SS CONNECTING ROD 8*400MM
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
HII SS CONNECTING ROD 8*450MM
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
HII SS CONNECTING ROD 8*450MM
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
HII SS CONNECTING ROD 8*500MM
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
HII SS CONNECTING ROD 8*500MM
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
HII SS CONNECTING ROD 8*65MM
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$798.72 |
| Rate for Payer: Aetna Commercial |
$640.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.96
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cigna Commercial |
$690.56
|
| Rate for Payer: First Health Commercial |
$790.40
|
| Rate for Payer: Humana Commercial |
$707.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$682.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$614.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$732.16
|
| Rate for Payer: Ohio Health Group HMO |
$624.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.08
|
| Rate for Payer: PHCS Commercial |
$798.72
|
| Rate for Payer: United Healthcare All Payer |
$732.16
|
|
|
HII SS CONNECTING ROD 8*65MM
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$798.72 |
| Rate for Payer: Aetna Commercial |
$640.64
|
| Rate for Payer: Anthem Medicaid |
$286.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.96
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cigna Commercial |
$690.56
|
| Rate for Payer: First Health Commercial |
$790.40
|
| Rate for Payer: Humana Commercial |
$707.20
|
| Rate for Payer: Humana KY Medicaid |
$286.12
|
| Rate for Payer: Kentucky WC Medicaid |
$289.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$682.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$614.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$732.16
|
| Rate for Payer: Ohio Health Group HMO |
$624.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.08
|
| Rate for Payer: PHCS Commercial |
$798.72
|
| Rate for Payer: United Healthcare All Payer |
$732.16
|
|
|
HINGE COMPASS UNIVERSAL
|
Facility
|
OP
|
$29,549.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,864.92 |
| Max. Negotiated Rate |
$28,367.76 |
| Rate for Payer: Aetna Commercial |
$22,753.31
|
| Rate for Payer: Anthem Medicaid |
$10,162.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,048.81
|
| Rate for Payer: Cash Price |
$14,774.88
|
| Rate for Payer: Cigna Commercial |
$24,526.29
|
| Rate for Payer: First Health Commercial |
$28,072.26
|
| Rate for Payer: Humana Commercial |
$25,117.29
|
| Rate for Payer: Humana KY Medicaid |
$10,162.16
|
| Rate for Payer: Kentucky WC Medicaid |
$10,265.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,230.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,807.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,864.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,366.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,003.78
|
| Rate for Payer: Ohio Health Group HMO |
$22,162.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,639.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,708.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,389.33
|
| Rate for Payer: PHCS Commercial |
$28,367.76
|
| Rate for Payer: United Healthcare All Payer |
$26,003.78
|
|
|
HINGE COMPASS UNIVERSAL
|
Facility
|
IP
|
$29,549.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,864.92 |
| Max. Negotiated Rate |
$28,367.76 |
| Rate for Payer: Aetna Commercial |
$22,753.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,048.81
|
| Rate for Payer: Cash Price |
$14,774.88
|
| Rate for Payer: Cigna Commercial |
$24,526.29
|
| Rate for Payer: First Health Commercial |
$28,072.26
|
| Rate for Payer: Humana Commercial |
$25,117.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,230.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,807.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,864.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,003.78
|
| Rate for Payer: Ohio Health Group HMO |
$22,162.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,639.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,708.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,389.33
|
| Rate for Payer: PHCS Commercial |
$28,367.76
|
| Rate for Payer: United Healthcare All Payer |
$26,003.78
|
|
|
HINGE FEM COMPON
|
Facility
|
OP
|
$40,760.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,228.28 |
| Max. Negotiated Rate |
$39,130.50 |
| Rate for Payer: Aetna Commercial |
$31,385.92
|
| Rate for Payer: Anthem Medicaid |
$14,017.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,793.53
|
| Rate for Payer: Cash Price |
$20,380.47
|
| Rate for Payer: Cigna Commercial |
$33,831.58
|
| Rate for Payer: First Health Commercial |
$38,722.89
|
| Rate for Payer: Humana Commercial |
$34,646.80
|
| Rate for Payer: Humana KY Medicaid |
$14,017.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,160.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,423.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,228.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,298.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,869.63
|
| Rate for Payer: Ohio Health Group HMO |
$30,570.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,608.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,462.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,125.05
|
| Rate for Payer: PHCS Commercial |
$39,130.50
|
| Rate for Payer: United Healthcare All Payer |
$35,869.63
|
|
|
HINGE FEM COMPON
|
Facility
|
IP
|
$40,760.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,228.28 |
| Max. Negotiated Rate |
$39,130.50 |
| Rate for Payer: Aetna Commercial |
$31,385.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,793.53
|
| Rate for Payer: Cash Price |
$20,380.47
|
| Rate for Payer: Cigna Commercial |
$33,831.58
|
| Rate for Payer: First Health Commercial |
$38,722.89
|
| Rate for Payer: Humana Commercial |
$34,646.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,423.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,228.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,869.63
|
| Rate for Payer: Ohio Health Group HMO |
$30,570.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,608.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,462.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,125.05
|
| Rate for Payer: PHCS Commercial |
$39,130.50
|
| Rate for Payer: United Healthcare All Payer |
$35,869.63
|
|
|
HINGE FEM DISTAL AUGMENT
|
Facility
|
OP
|
$9,706.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,912.06 |
| Max. Negotiated Rate |
$9,318.60 |
| Rate for Payer: Aetna Commercial |
$7,474.30
|
| Rate for Payer: Anthem Medicaid |
$3,338.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,571.37
|
| Rate for Payer: Cash Price |
$4,853.44
|
| Rate for Payer: Cigna Commercial |
$8,056.71
|
| Rate for Payer: First Health Commercial |
$9,221.54
|
| Rate for Payer: Humana Commercial |
$8,250.85
|
| Rate for Payer: Humana KY Medicaid |
$3,338.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,372.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,959.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,163.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,405.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,542.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,280.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,444.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,697.75
|
| Rate for Payer: PHCS Commercial |
$9,318.60
|
| Rate for Payer: United Healthcare All Payer |
$8,542.05
|
|
|
HINGE FEM DISTAL AUGMENT
|
Facility
|
IP
|
$9,706.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,912.06 |
| Max. Negotiated Rate |
$9,318.60 |
| Rate for Payer: Aetna Commercial |
$7,474.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,571.37
|
| Rate for Payer: Cash Price |
$4,853.44
|
| Rate for Payer: Cigna Commercial |
$8,056.71
|
| Rate for Payer: First Health Commercial |
$9,221.54
|
| Rate for Payer: Humana Commercial |
$8,250.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,959.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,163.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,912.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,542.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,280.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,444.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,697.75
|
| Rate for Payer: PHCS Commercial |
$9,318.60
|
| Rate for Payer: United Healthcare All Payer |
$8,542.05
|
|
|
HINGE FEMORAL COMPONENT
|
Facility
|
OP
|
$40,760.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,228.28 |
| Max. Negotiated Rate |
$39,130.50 |
| Rate for Payer: Aetna Commercial |
$31,385.92
|
| Rate for Payer: Anthem Medicaid |
$14,017.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,793.53
|
| Rate for Payer: Cash Price |
$20,380.47
|
| Rate for Payer: Cigna Commercial |
$33,831.58
|
| Rate for Payer: First Health Commercial |
$38,722.89
|
| Rate for Payer: Humana Commercial |
$34,646.80
|
| Rate for Payer: Humana KY Medicaid |
$14,017.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,160.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,423.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,228.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,298.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,869.63
|
| Rate for Payer: Ohio Health Group HMO |
$30,570.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,608.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,462.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,125.05
|
| Rate for Payer: PHCS Commercial |
$39,130.50
|
| Rate for Payer: United Healthcare All Payer |
$35,869.63
|
|
|
HINGE FEMORAL COMPONENT
|
Facility
|
IP
|
$40,760.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,228.28 |
| Max. Negotiated Rate |
$39,130.50 |
| Rate for Payer: Aetna Commercial |
$31,385.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,793.53
|
| Rate for Payer: Cash Price |
$20,380.47
|
| Rate for Payer: Cigna Commercial |
$33,831.58
|
| Rate for Payer: First Health Commercial |
$38,722.89
|
| Rate for Payer: Humana Commercial |
$34,646.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,423.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,228.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,869.63
|
| Rate for Payer: Ohio Health Group HMO |
$30,570.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,608.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,462.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,125.05
|
| Rate for Payer: PHCS Commercial |
$39,130.50
|
| Rate for Payer: United Healthcare All Payer |
$35,869.63
|
|
|
HINGE FEMORAL COMPONENT #6 LT
|
Facility
|
IP
|
$40,760.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,228.28 |
| Max. Negotiated Rate |
$39,130.50 |
| Rate for Payer: Aetna Commercial |
$31,385.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,793.53
|
| Rate for Payer: Cash Price |
$20,380.47
|
| Rate for Payer: Cigna Commercial |
$33,831.58
|
| Rate for Payer: First Health Commercial |
$38,722.89
|
| Rate for Payer: Humana Commercial |
$34,646.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,423.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,228.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,869.63
|
| Rate for Payer: Ohio Health Group HMO |
$30,570.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,608.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,462.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,125.05
|
| Rate for Payer: PHCS Commercial |
$39,130.50
|
| Rate for Payer: United Healthcare All Payer |
$35,869.63
|
|
|
HINGE FEMORAL COMPONENT #6 LT
|
Facility
|
OP
|
$40,760.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,228.28 |
| Max. Negotiated Rate |
$39,130.50 |
| Rate for Payer: Aetna Commercial |
$31,385.92
|
| Rate for Payer: Anthem Medicaid |
$14,017.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,793.53
|
| Rate for Payer: Cash Price |
$20,380.47
|
| Rate for Payer: Cigna Commercial |
$33,831.58
|
| Rate for Payer: First Health Commercial |
$38,722.89
|
| Rate for Payer: Humana Commercial |
$34,646.80
|
| Rate for Payer: Humana KY Medicaid |
$14,017.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,160.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,423.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,228.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,298.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,869.63
|
| Rate for Payer: Ohio Health Group HMO |
$30,570.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,608.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,462.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,125.05
|
| Rate for Payer: PHCS Commercial |
$39,130.50
|
| Rate for Payer: United Healthcare All Payer |
$35,869.63
|
|
|
HINGE INSERT
|
Facility
|
OP
|
$14,270.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,281.16 |
| Max. Negotiated Rate |
$13,699.71 |
| Rate for Payer: Aetna Commercial |
$10,988.31
|
| Rate for Payer: Anthem Medicaid |
$4,907.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,131.01
|
| Rate for Payer: Cash Price |
$7,135.27
|
| Rate for Payer: Cigna Commercial |
$11,844.54
|
| Rate for Payer: First Health Commercial |
$13,557.00
|
| Rate for Payer: Humana Commercial |
$12,129.95
|
| Rate for Payer: Humana KY Medicaid |
$4,907.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,957.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,701.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,531.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,281.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,006.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,558.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,702.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,416.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,415.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,846.67
|
| Rate for Payer: PHCS Commercial |
$13,699.71
|
| Rate for Payer: United Healthcare All Payer |
$12,558.07
|
|
|
HINGE INSERT
|
Facility
|
IP
|
$14,270.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,281.16 |
| Max. Negotiated Rate |
$13,699.71 |
| Rate for Payer: Aetna Commercial |
$10,988.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,131.01
|
| Rate for Payer: Cash Price |
$7,135.27
|
| Rate for Payer: Cigna Commercial |
$11,844.54
|
| Rate for Payer: First Health Commercial |
$13,557.00
|
| Rate for Payer: Humana Commercial |
$12,129.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,701.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,531.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,281.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,558.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,702.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,416.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,415.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,846.67
|
| Rate for Payer: PHCS Commercial |
$13,699.71
|
| Rate for Payer: United Healthcare All Payer |
$12,558.07
|
|
|
HINGE NXGN ROTART SUR B 12 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 12 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 14 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
