|
INSERT TS TIBIAL #11/21MM 9T
|
Facility
|
IP
|
$8,321.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.82 |
| Max. Negotiated Rate |
$7,988.85 |
| Rate for Payer: Aetna Commercial |
$6,407.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.94
|
| Rate for Payer: Cash Price |
$4,160.86
|
| Rate for Payer: Cigna Commercial |
$6,907.03
|
| Rate for Payer: First Health Commercial |
$7,905.63
|
| Rate for Payer: Humana Commercial |
$7,073.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,579.73
|
| Rate for Payer: PHCS Commercial |
$7,988.85
|
| Rate for Payer: United Healthcare All Payer |
$7,323.11
|
|
|
INSERT TS TIBIAL #11/21MM 9T
|
Facility
|
OP
|
$8,321.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.82 |
| Max. Negotiated Rate |
$7,988.85 |
| Rate for Payer: Aetna Commercial |
$6,407.72
|
| Rate for Payer: Anthem Medicaid |
$2,861.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.94
|
| Rate for Payer: Cash Price |
$4,160.86
|
| Rate for Payer: Cigna Commercial |
$6,907.03
|
| Rate for Payer: First Health Commercial |
$7,905.63
|
| Rate for Payer: Humana Commercial |
$7,073.46
|
| Rate for Payer: Humana KY Medicaid |
$2,861.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,579.73
|
| Rate for Payer: PHCS Commercial |
$7,988.85
|
| Rate for Payer: United Healthcare All Payer |
$7,323.11
|
|
|
INSERT TS TIBIAL #11/24MM
|
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 #11/24MM
|
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
|
|
|
INSERT TS TIBIAL #11/24MM 9T
|
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
|
|
|
INSERT TS TIBIAL #11/24MM 9T
|
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 #3/10MM
|
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 #3/10MM
|
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
|
|
|
INSERT TS TIBIAL #3/12MM
|
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
|
|
|
INSERT TS TIBIAL #3/12MM
|
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 #3/14MM
|
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
|
|
|
INSERT TS TIBIAL #3/14MM
|
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 #3/16MM
|
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
|
|
|
INSERT TS TIBIAL #3/16MM
|
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 #3/18MM
|
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 #3/18MM
|
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
|
|
|
INSERT TS TIBIAL #3/21MM
|
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 #3/21MM
|
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
|
|
|
INSERT TS TIBIAL #3/24MM
|
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 #3/24MM
|
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
|
|
|
INSERT TS TIBIAL #5/10MM
|
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 #5/10MM
|
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 #5/10MM 7T
|
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 #5/10MM 7T
|
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 #5/12MM
|
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
|
|
