|
INSERT TS TIBIAL #9/14MM
|
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 #9/14MM
|
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 #9/14MM 11T
|
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 #9/14MM 11T
|
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 #9/16MM
|
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 #9/16MM
|
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 #9/16MM 11T
|
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 #9/16MM 11T
|
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 #9/18MM
|
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 #9/18MM
|
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 #9/18MM 11T
|
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 #9/18MM 11T
|
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 #9/21MM
|
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 #9/21MM
|
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 #9/21MM 11T
|
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 #9/21MM 11T
|
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 #9/24MM
|
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 #9/24MM
|
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 #9/24MM 11T
|
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 #9/24MM 11T
|
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 TUN IP CATH PERC
|
Facility
|
OP
|
$8,603.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
76101999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,958.71 |
| Max. Negotiated Rate |
$8,259.27 |
| Rate for Payer: Aetna Commercial |
$6,624.63
|
| Rate for Payer: Anthem Medicaid |
$2,958.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,710.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cigna Commercial |
$7,140.83
|
| Rate for Payer: First Health Commercial |
$8,173.24
|
| Rate for Payer: Humana Commercial |
$7,312.90
|
| Rate for Payer: Humana KY Medicaid |
$2,958.71
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,054.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,452.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,882.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,484.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.35
|
| Rate for Payer: PHCS Commercial |
$8,259.27
|
| Rate for Payer: United Healthcare All Payer |
$7,571.00
|
|
|
INSERT TUN IP CATH PERC
|
Professional
|
Both
|
$8,603.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
76101999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$5,162.05 |
| Rate for Payer: Aetna Commercial |
$379.33
|
| Rate for Payer: Ambetter Exchange |
$187.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.45
|
| Rate for Payer: Anthem Medicaid |
$1,326.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.11
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cigna Commercial |
$2,482.81
|
| Rate for Payer: Healthspan PPO |
$1,496.16
|
| Rate for Payer: Humana Medicaid |
$1,326.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,353.08
|
| Rate for Payer: Molina Healthcare Passport |
$1,326.55
|
| Rate for Payer: Multiplan PHCS |
$5,162.05
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.87
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,339.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.59
|
|
|
INSERT TUN IP CATH PERC
|
Facility
|
IP
|
$8,603.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
76101999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,581.02 |
| Max. Negotiated Rate |
$8,259.27 |
| Rate for Payer: Aetna Commercial |
$6,624.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,710.66
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cigna Commercial |
$7,140.83
|
| Rate for Payer: First Health Commercial |
$8,173.24
|
| Rate for Payer: Humana Commercial |
$7,312.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,054.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,452.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,882.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,484.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.35
|
| Rate for Payer: PHCS Commercial |
$8,259.27
|
| Rate for Payer: United Healthcare All Payer |
$7,571.00
|
|
|
INSERT TUN IP CATH PERC(P
|
Professional
|
Both
|
$2,180.00
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
761P1999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$2,482.81 |
| Rate for Payer: Aetna Commercial |
$379.33
|
| Rate for Payer: Ambetter Exchange |
$187.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.45
|
| Rate for Payer: Anthem Medicaid |
$1,326.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.11
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cigna Commercial |
$2,482.81
|
| Rate for Payer: Healthspan PPO |
$1,496.16
|
| Rate for Payer: Humana Medicaid |
$1,326.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,353.08
|
| Rate for Payer: Molina Healthcare Passport |
$1,326.55
|
| Rate for Payer: Multiplan PHCS |
$1,308.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.87
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,339.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.59
|
|
|
INSERT TUN IP CATH PERC(T
|
Facility
|
IP
|
$6,423.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
761T1999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,927.02 |
| Max. Negotiated Rate |
$6,166.47 |
| Rate for Payer: Aetna Commercial |
$4,946.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,010.26
|
| Rate for Payer: Cash Price |
$3,211.70
|
| Rate for Payer: Cigna Commercial |
$5,331.43
|
| Rate for Payer: First Health Commercial |
$6,102.24
|
| Rate for Payer: Humana Commercial |
$5,459.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,267.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,740.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,927.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,652.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,817.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,138.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,588.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,432.15
|
| Rate for Payer: PHCS Commercial |
$6,166.47
|
| Rate for Payer: United Healthcare All Payer |
$5,652.60
|
|
