|
INSERT TS TIBIAL #5/12MM
|
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 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 #5/12MM 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 #5/14MM
|
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 #5/14MM
|
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 #5/14MM 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 #5/14MM 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 #5/16MM
|
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 #5/16MM
|
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 #5/16MM 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 #5/16MM 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 #5/18MM
|
Facility
|
IP
|
$7,860.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.85 |
| Max. Negotiated Rate |
$7,545.95 |
| Rate for Payer: Aetna Commercial |
$6,052.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.08
|
| Rate for Payer: Cash Price |
$3,930.18
|
| Rate for Payer: Cigna Commercial |
$6,524.10
|
| Rate for Payer: First Health Commercial |
$7,467.34
|
| Rate for Payer: Humana Commercial |
$6,681.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,800.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,358.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.71
|
| Rate for Payer: PHCS Commercial |
$7,545.95
|
| Rate for Payer: United Healthcare All Payer |
$6,917.12
|
|
|
INSERT TS TIBIAL #5/18MM
|
Facility
|
OP
|
$7,860.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.85 |
| Max. Negotiated Rate |
$7,545.95 |
| Rate for Payer: Aetna Commercial |
$6,052.48
|
| Rate for Payer: Anthem Medicaid |
$2,703.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.08
|
| Rate for Payer: Cash Price |
$3,930.18
|
| Rate for Payer: Cigna Commercial |
$6,524.10
|
| Rate for Payer: First Health Commercial |
$7,467.34
|
| Rate for Payer: Humana Commercial |
$6,681.31
|
| Rate for Payer: Humana KY Medicaid |
$2,703.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,800.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,358.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,757.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.71
|
| Rate for Payer: PHCS Commercial |
$7,545.95
|
| Rate for Payer: United Healthcare All Payer |
$6,917.12
|
|
|
INSERT TS TIBIAL #5/18MM 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 #5/18MM 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 #5/21MM
|
Facility
|
IP
|
$8,009.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.21 |
| Max. Negotiated Rate |
$7,688.91 |
| Rate for Payer: Aetna Commercial |
$6,167.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,247.24
|
| Rate for Payer: Cash Price |
$4,004.64
|
| Rate for Payer: Cigna Commercial |
$6,647.70
|
| Rate for Payer: First Health Commercial |
$7,608.82
|
| Rate for Payer: Humana Commercial |
$6,807.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,567.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,910.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,402.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,048.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,006.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,482.88
|
| Rate for Payer: PHCS Commercial |
$7,688.91
|
| Rate for Payer: United Healthcare All Payer |
$7,048.17
|
|
|
INSERT TS TIBIAL #5/21MM
|
Facility
|
OP
|
$8,009.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.21 |
| Max. Negotiated Rate |
$7,688.91 |
| Rate for Payer: Aetna Commercial |
$6,167.15
|
| Rate for Payer: Anthem Medicaid |
$2,754.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,247.24
|
| Rate for Payer: Cash Price |
$4,004.64
|
| Rate for Payer: Cigna Commercial |
$6,647.70
|
| Rate for Payer: First Health Commercial |
$7,608.82
|
| Rate for Payer: Humana Commercial |
$6,807.89
|
| Rate for Payer: Humana KY Medicaid |
$2,754.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,782.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,567.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,910.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,402.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,809.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,048.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,006.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,482.88
|
| Rate for Payer: PHCS Commercial |
$7,688.91
|
| Rate for Payer: United Healthcare All Payer |
$7,048.17
|
|
|
INSERT TS TIBIAL #5/21MM 7T
|
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 #5/21MM 7T
|
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 #5/24MM
|
Facility
|
OP
|
$7,536.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.71 |
| Max. Negotiated Rate |
$7,234.79 |
| Rate for Payer: Aetna Commercial |
$5,802.90
|
| Rate for Payer: Anthem Medicaid |
$2,591.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,878.27
|
| Rate for Payer: Cash Price |
$3,768.12
|
| Rate for Payer: Cigna Commercial |
$6,255.08
|
| Rate for Payer: First Health Commercial |
$7,159.43
|
| Rate for Payer: Humana Commercial |
$6,405.80
|
| Rate for Payer: Humana KY Medicaid |
$2,591.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,618.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,179.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,561.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,260.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,643.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,631.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,652.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,336.23
|
| Rate for Payer: PHCS Commercial |
$7,234.79
|
| Rate for Payer: United Healthcare All Payer |
$6,631.89
|
|
|
INSERT TS TIBIAL #5/24MM
|
Facility
|
IP
|
$7,536.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.71 |
| Max. Negotiated Rate |
$7,234.79 |
| Rate for Payer: Aetna Commercial |
$5,802.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,878.27
|
| Rate for Payer: Cash Price |
$3,768.12
|
| Rate for Payer: Cigna Commercial |
$6,255.08
|
| Rate for Payer: First Health Commercial |
$7,159.43
|
| Rate for Payer: Humana Commercial |
$6,405.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,179.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,561.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,260.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,631.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,652.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,336.23
|
| Rate for Payer: PHCS Commercial |
$7,234.79
|
| Rate for Payer: United Healthcare All Payer |
$6,631.89
|
|
|
INSERT TS TIBIAL #5/24MM 7T
|
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 #5/24MM 7T
|
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 #7/10MM 5T
|
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 #7/10MM 5T
|
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
|
|
