|
INSERT TS TIBIAL #3/10MM
|
Facility
|
OP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem Medicaid |
$2,485.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Humana KY Medicaid |
$2,485.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/12MM
|
Facility
|
IP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/12MM
|
Facility
|
OP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem Medicaid |
$2,485.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Humana KY Medicaid |
$2,485.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/14MM
|
Facility
|
OP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem Medicaid |
$2,485.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Humana KY Medicaid |
$2,485.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/14MM
|
Facility
|
IP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/16MM
|
Facility
|
IP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/16MM
|
Facility
|
OP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem Medicaid |
$2,485.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Humana KY Medicaid |
$2,485.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/18MM
|
Facility
|
OP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem Medicaid |
$2,485.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Humana KY Medicaid |
$2,485.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/18MM
|
Facility
|
IP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/21MM
|
Facility
|
IP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/21MM
|
Facility
|
OP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem Medicaid |
$2,485.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Humana KY Medicaid |
$2,485.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/24MM
|
Facility
|
IP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #3/24MM
|
Facility
|
OP
|
$7,228.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.45 |
| Max. Negotiated Rate |
$6,939.03 |
| Rate for Payer: Aetna Commercial |
$5,565.68
|
| Rate for Payer: Anthem Medicaid |
$2,485.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.96
|
| Rate for Payer: Cash Price |
$3,614.08
|
| Rate for Payer: Cigna Commercial |
$5,999.37
|
| Rate for Payer: First Health Commercial |
$6,866.75
|
| Rate for Payer: Humana Commercial |
$6,143.94
|
| Rate for Payer: Humana KY Medicaid |
$2,485.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,927.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,334.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,421.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,782.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.43
|
| Rate for Payer: PHCS Commercial |
$6,939.03
|
| Rate for Payer: United Healthcare All Payer |
$6,360.78
|
|
|
INSERT TS TIBIAL #5/10MM
|
Facility
|
IP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/10MM
|
Facility
|
OP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem Medicaid |
$2,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Humana KY Medicaid |
$2,443.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/10MM 7T
|
Facility
|
IP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/10MM 7T
|
Facility
|
OP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem Medicaid |
$2,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Humana KY Medicaid |
$2,443.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/12MM
|
Facility
|
OP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem Medicaid |
$2,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Humana KY Medicaid |
$2,443.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/12MM
|
Facility
|
IP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/12MM 7T
|
Facility
|
OP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem Medicaid |
$2,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Humana KY Medicaid |
$2,443.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/12MM 7T
|
Facility
|
IP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/14MM
|
Facility
|
OP
|
$8,364.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.21 |
| Max. Negotiated Rate |
$8,029.48 |
| Rate for Payer: Aetna Commercial |
$6,440.31
|
| Rate for Payer: Anthem Medicaid |
$2,876.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,523.95
|
| Rate for Payer: Cash Price |
$4,182.02
|
| Rate for Payer: Cigna Commercial |
$6,942.15
|
| Rate for Payer: First Health Commercial |
$7,945.84
|
| Rate for Payer: Humana Commercial |
$7,109.43
|
| Rate for Payer: Humana KY Medicaid |
$2,876.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,905.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,858.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,172.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,360.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,273.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,691.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,276.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,771.19
|
| Rate for Payer: PHCS Commercial |
$8,029.48
|
| Rate for Payer: United Healthcare All Payer |
$7,360.36
|
|
|
INSERT TS TIBIAL #5/14MM
|
Facility
|
IP
|
$8,364.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.21 |
| Max. Negotiated Rate |
$8,029.48 |
| Rate for Payer: Aetna Commercial |
$6,440.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,523.95
|
| Rate for Payer: Cash Price |
$4,182.02
|
| Rate for Payer: Cigna Commercial |
$6,942.15
|
| Rate for Payer: First Health Commercial |
$7,945.84
|
| Rate for Payer: Humana Commercial |
$7,109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,858.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,172.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,360.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,273.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,691.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,276.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,771.19
|
| Rate for Payer: PHCS Commercial |
$8,029.48
|
| Rate for Payer: United Healthcare All Payer |
$7,360.36
|
|
|
INSERT TS TIBIAL #5/14MM 7T
|
Facility
|
IP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
|
INSERT TS TIBIAL #5/14MM 7T
|
Facility
|
OP
|
$7,105.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.66 |
| Max. Negotiated Rate |
$6,821.30 |
| Rate for Payer: Aetna Commercial |
$5,471.25
|
| Rate for Payer: Anthem Medicaid |
$2,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.31
|
| Rate for Payer: Cash Price |
$3,552.76
|
| Rate for Payer: Cigna Commercial |
$5,897.58
|
| Rate for Payer: First Health Commercial |
$6,750.24
|
| Rate for Payer: Humana Commercial |
$6,039.69
|
| Rate for Payer: Humana KY Medicaid |
$2,443.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,826.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,252.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,684.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,181.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,902.81
|
| Rate for Payer: PHCS Commercial |
$6,821.30
|
| Rate for Payer: United Healthcare All Payer |
$6,252.86
|
|
