|
OPTETRAK FEM COMP POST SZ2.5 R
|
Facility
|
OP
|
$16,306.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,891.98 |
| Max. Negotiated Rate |
$15,654.34 |
| Rate for Payer: Aetna Commercial |
$12,556.08
|
| Rate for Payer: Anthem Medicaid |
$5,607.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,719.15
|
| Rate for Payer: Cash Price |
$8,153.30
|
| Rate for Payer: Cigna Commercial |
$13,534.48
|
| Rate for Payer: First Health Commercial |
$15,491.27
|
| Rate for Payer: Humana Commercial |
$13,860.61
|
| Rate for Payer: Humana KY Medicaid |
$5,607.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,664.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,371.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,034.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,891.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,720.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,349.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,229.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,045.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,186.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,251.55
|
| Rate for Payer: PHCS Commercial |
$15,654.34
|
| Rate for Payer: United Healthcare All Payer |
$14,349.81
|
|
|
OPTETRAK PEG PATELLA 35MM
|
Facility
|
OP
|
$4,058.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.62 |
| Max. Negotiated Rate |
$3,896.40 |
| Rate for Payer: Aetna Commercial |
$3,125.24
|
| Rate for Payer: Anthem Medicaid |
$1,395.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,165.82
|
| Rate for Payer: Cash Price |
$2,029.38
|
| Rate for Payer: Cigna Commercial |
$3,368.76
|
| Rate for Payer: First Health Commercial |
$3,855.81
|
| Rate for Payer: Humana Commercial |
$3,449.94
|
| Rate for Payer: Humana KY Medicaid |
$1,395.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,410.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,328.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,995.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,217.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,423.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,044.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,247.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,531.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,800.54
|
| Rate for Payer: PHCS Commercial |
$3,896.40
|
| Rate for Payer: United Healthcare All Payer |
$3,571.70
|
|
|
OPTETRAK PEG PATELLA 35MM
|
Facility
|
IP
|
$4,058.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.62 |
| Max. Negotiated Rate |
$3,896.40 |
| Rate for Payer: Aetna Commercial |
$3,125.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,165.82
|
| Rate for Payer: Cash Price |
$2,029.38
|
| Rate for Payer: Cigna Commercial |
$3,368.76
|
| Rate for Payer: First Health Commercial |
$3,855.81
|
| Rate for Payer: Humana Commercial |
$3,449.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,328.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,995.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,217.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,044.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,247.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,531.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,800.54
|
| Rate for Payer: PHCS Commercial |
$3,896.40
|
| Rate for Payer: United Healthcare All Payer |
$3,571.70
|
|
|
OPTETRAK TIB INSRT SZ 2.5 11MM
|
Facility
|
IP
|
$6,825.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,047.56 |
| Max. Negotiated Rate |
$6,552.19 |
| Rate for Payer: Aetna Commercial |
$5,255.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,323.66
|
| Rate for Payer: Cash Price |
$3,412.60
|
| Rate for Payer: Cigna Commercial |
$5,664.92
|
| Rate for Payer: First Health Commercial |
$6,483.94
|
| Rate for Payer: Humana Commercial |
$5,801.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,596.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,037.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,047.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,006.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,118.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,460.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,937.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,709.39
|
| Rate for Payer: PHCS Commercial |
$6,552.19
|
| Rate for Payer: United Healthcare All Payer |
$6,006.18
|
|
|
OPTETRAK TIB INSRT SZ 2.5 11MM
|
Facility
|
OP
|
$6,825.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,047.56 |
| Max. Negotiated Rate |
$6,552.19 |
| Rate for Payer: Aetna Commercial |
$5,255.40
|
| Rate for Payer: Anthem Medicaid |
$2,347.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,323.66
|
| Rate for Payer: Cash Price |
$3,412.60
|
| Rate for Payer: Cigna Commercial |
$5,664.92
|
| Rate for Payer: First Health Commercial |
$6,483.94
|
| Rate for Payer: Humana Commercial |
$5,801.42
|
| Rate for Payer: Humana KY Medicaid |
$2,347.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,371.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,596.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,037.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,047.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,394.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,006.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,118.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,460.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,937.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,709.39
|
| Rate for Payer: PHCS Commercial |
$6,552.19
|
| Rate for Payer: United Healthcare All Payer |
$6,006.18
|
|
|
OPTETRAK TIB INS SZ 2.5F/2.5T
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
OPTETRAK TIB INS SZ 2.5F/2.5T
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
OPTI-FIX COLLARED STEM SZ 5.25
|
Facility
|
IP
|
$15,841.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,752.45 |
| Max. Negotiated Rate |
$15,207.85 |
| Rate for Payer: Aetna Commercial |
$12,197.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,356.38
|
| Rate for Payer: Cash Price |
$7,920.76
|
| Rate for Payer: Cigna Commercial |
$13,148.45
|
| Rate for Payer: First Health Commercial |
$15,049.43
|
| Rate for Payer: Humana Commercial |
$13,465.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,990.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,691.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,752.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,940.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,881.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,673.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,782.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,930.64
|
| Rate for Payer: PHCS Commercial |
$15,207.85
|
| Rate for Payer: United Healthcare All Payer |
$13,940.53
|
|
|
OPTI-FIX COLLARED STEM SZ 5.25
|
Facility
|
OP
|
$15,841.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,752.45 |
| Max. Negotiated Rate |
$15,207.85 |
| Rate for Payer: Aetna Commercial |
$12,197.96
|
| Rate for Payer: Anthem Medicaid |
$5,447.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,356.38
|
| Rate for Payer: Cash Price |
$7,920.76
|
| Rate for Payer: Cigna Commercial |
$13,148.45
|
| Rate for Payer: First Health Commercial |
$15,049.43
|
| Rate for Payer: Humana Commercial |
$13,465.28
|
| Rate for Payer: Humana KY Medicaid |
$5,447.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,503.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,990.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,691.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,752.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,557.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,940.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,881.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,673.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,782.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,930.64
|
| Rate for Payer: PHCS Commercial |
$15,207.85
|
| Rate for Payer: United Healthcare All Payer |
$13,940.53
|
|
|
OPTI-FIX XLPE 22 20 DEG 44-45
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 22 20 DEG 44-45
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 22 20 DEG 46-48
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 22 20 DEG 46-48
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 46-48
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 46-48
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 50-54
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 50-54
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 46-48
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 46-48
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 50-54
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 50-54
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 56-62
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 56-62
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 63-74
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 63-74
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
