|
INSERT TRANSVENOUS ELECTRODE
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 33216
|
| Hospital Charge Code |
76101250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$10,285.34 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
INSERT TRANSVENOUS ELECTRODE
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 33216
|
| Hospital Charge Code |
76101250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
INSERT TRANSVENOUS ELECTRODE(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 33216
|
| Hospital Charge Code |
761P1250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.78 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$648.38
|
| Rate for Payer: Anthem Medicaid |
$296.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$616.13
|
| Rate for Payer: Healthspan PPO |
$637.48
|
| Rate for Payer: Humana Medicaid |
$296.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$531.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$302.72
|
| Rate for Payer: Molina Healthcare Passport |
$296.78
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.75
|
|
|
INSERT TS TIBIAL #11/10MM
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/10MM
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/10MM 9T
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/10MM 9T
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/12MM
|
Facility
|
OP
|
$8,164.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.33 |
| Max. Negotiated Rate |
$7,837.48 |
| Rate for Payer: Aetna Commercial |
$6,286.31
|
| Rate for Payer: Anthem Medicaid |
$2,807.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,367.95
|
| Rate for Payer: Cash Price |
$4,082.02
|
| Rate for Payer: Cigna Commercial |
$6,776.15
|
| Rate for Payer: First Health Commercial |
$7,755.84
|
| Rate for Payer: Humana Commercial |
$6,939.43
|
| Rate for Payer: Humana KY Medicaid |
$2,807.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,694.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,025.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,863.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,184.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,123.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.85
|
| Rate for Payer: PHCS Commercial |
$7,837.48
|
| Rate for Payer: United Healthcare All Payer |
$7,184.36
|
|
|
INSERT TS TIBIAL #11/12MM
|
Facility
|
IP
|
$8,164.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.33 |
| Max. Negotiated Rate |
$7,837.48 |
| Rate for Payer: Aetna Commercial |
$6,286.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,367.95
|
| Rate for Payer: Cash Price |
$4,082.02
|
| Rate for Payer: Cigna Commercial |
$6,776.15
|
| Rate for Payer: First Health Commercial |
$7,755.84
|
| Rate for Payer: Humana Commercial |
$6,939.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,694.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,025.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,184.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,123.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.85
|
| Rate for Payer: PHCS Commercial |
$7,837.48
|
| Rate for Payer: United Healthcare All Payer |
$7,184.36
|
|
|
INSERT TS TIBIAL #11/12MM 9T
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/12MM 9T
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/14MM
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/14MM
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/14MM 9T
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/14MM 9T
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/16MM
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/16MM
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/16MM 9T
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/16MM 9T
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/18MM
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/18MM
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/18MM 9T
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/18MM 9T
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #11/21MM
|
Facility
|
OP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem Medicaid |
$2,416.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Humana KY Medicaid |
$2,416.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #11/21MM
|
Facility
|
IP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
