|
TIB GNS II CMT W/O TAPER SZ8 R
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIA FIXED BEARING 2-PEG F
|
Facility
|
IP
|
$10,928.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.70 |
| Max. Negotiated Rate |
$10,491.36 |
| Rate for Payer: Aetna Commercial |
$8,414.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,524.23
|
| Rate for Payer: Cash Price |
$5,464.25
|
| Rate for Payer: Cigna Commercial |
$9,070.66
|
| Rate for Payer: First Health Commercial |
$10,382.08
|
| Rate for Payer: Humana Commercial |
$9,289.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,961.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,065.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,278.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,617.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,196.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,185.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,387.84
|
| Rate for Payer: PHCS Commercial |
$10,491.36
|
| Rate for Payer: United Healthcare All Payer |
$9,617.08
|
|
|
TIBIA FIXED BEARING 2-PEG F
|
Facility
|
OP
|
$10,928.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.70 |
| Max. Negotiated Rate |
$10,491.36 |
| Rate for Payer: Aetna Commercial |
$8,414.94
|
| Rate for Payer: Anthem Medicaid |
$3,758.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,524.23
|
| Rate for Payer: Cash Price |
$5,464.25
|
| Rate for Payer: Cigna Commercial |
$9,070.66
|
| Rate for Payer: First Health Commercial |
$10,382.08
|
| Rate for Payer: Humana Commercial |
$9,289.22
|
| Rate for Payer: Humana KY Medicaid |
$3,758.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,796.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,961.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,065.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,278.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,833.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,617.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,196.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,185.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,387.84
|
| Rate for Payer: PHCS Commercial |
$10,491.36
|
| Rate for Payer: United Healthcare All Payer |
$9,617.08
|
|
|
TIBIAL ANCHOR 9*25
|
Facility
|
OP
|
$1,710.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.32 |
| Max. Negotiated Rate |
$1,641.74 |
| Rate for Payer: Aetna Commercial |
$1,316.82
|
| Rate for Payer: Anthem Medicaid |
$588.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,333.92
|
| Rate for Payer: Cash Price |
$855.08
|
| Rate for Payer: Cigna Commercial |
$1,419.42
|
| Rate for Payer: First Health Commercial |
$1,624.64
|
| Rate for Payer: Humana Commercial |
$1,453.63
|
| Rate for Payer: Humana KY Medicaid |
$588.12
|
| Rate for Payer: Kentucky WC Medicaid |
$594.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,402.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$599.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,504.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.15
|
| Rate for Payer: PHCS Commercial |
$1,641.74
|
| Rate for Payer: United Healthcare All Payer |
$1,504.93
|
|
|
TIBIAL ANCHOR 9*25
|
Facility
|
IP
|
$1,710.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.32 |
| Max. Negotiated Rate |
$1,641.74 |
| Rate for Payer: Aetna Commercial |
$1,316.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,333.92
|
| Rate for Payer: Cash Price |
$855.08
|
| Rate for Payer: Cigna Commercial |
$1,419.42
|
| Rate for Payer: First Health Commercial |
$1,624.64
|
| Rate for Payer: Humana Commercial |
$1,453.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,402.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,504.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.15
|
| Rate for Payer: PHCS Commercial |
$1,641.74
|
| Rate for Payer: United Healthcare All Payer |
$1,504.93
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
76101091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$1,328.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: First Health Commercial |
$1,638.75
|
| Rate for Payer: Humana Commercial |
$1,466.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare All Payer |
$1,518.00
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
76101091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,163.20
|
| Rate for Payer: Anthem Medicaid |
$637.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,725.00
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,279.44
|
| Rate for Payer: Healthspan PPO |
$1,053.61
|
| Rate for Payer: Humana Medicaid |
$637.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$650.16
|
| Rate for Payer: Molina Healthcare Passport |
$637.41
|
| Rate for Payer: Multiplan PHCS |
$1,035.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,207.50
|
| Rate for Payer: UHCCP Medicaid |
$603.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$643.78
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
76101091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,328.25
|
| Rate for Payer: Anthem Medicaid |
$593.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: First Health Commercial |
$1,638.75
|
| Rate for Payer: Humana Commercial |
$1,466.25
|
| Rate for Payer: Humana KY Medicaid |
$593.23
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$599.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$605.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare All Payer |
$1,518.00
|
|
|
TIBIAL ARTHROSCOPY/SURGERY(P
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
761P1091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,163.20
|
| Rate for Payer: Anthem Medicaid |
$637.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,725.00
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,279.44
|
| Rate for Payer: Healthspan PPO |
$1,053.61
|
| Rate for Payer: Humana Medicaid |
$637.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$650.16
|
| Rate for Payer: Molina Healthcare Passport |
$637.41
|
| Rate for Payer: Multiplan PHCS |
$1,035.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,207.50
|
| Rate for Payer: UHCCP Medicaid |
$603.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$643.78
|
|
|
TIBIAL AUG NONPOROUS 1*10MM
|
Facility
|
OP
|
$9,180.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.43 |
| Max. Negotiated Rate |
$8,812.99 |
| Rate for Payer: Aetna Commercial |
$7,068.75
|
| Rate for Payer: Anthem Medicaid |
$3,157.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,160.56
|
| Rate for Payer: Cash Price |
$4,590.10
|
| Rate for Payer: Cigna Commercial |
$7,619.57
|
| Rate for Payer: First Health Commercial |
$8,721.19
|
| Rate for Payer: Humana Commercial |
$7,803.17
|
| Rate for Payer: Humana KY Medicaid |
$3,157.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,527.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,774.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,220.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,078.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,885.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,836.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.86
|
| Rate for Payer: PHCS Commercial |
$8,812.99
|
| Rate for Payer: United Healthcare All Payer |
$8,078.58
|
|
|
TIBIAL AUG NONPOROUS 1*10MM
|
Facility
|
IP
|
$9,180.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.43 |
| Max. Negotiated Rate |
$8,812.99 |
| Rate for Payer: Aetna Commercial |
$7,068.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,160.56
|
| Rate for Payer: Cash Price |
$4,590.10
|
| Rate for Payer: Cigna Commercial |
$7,619.57
|
| Rate for Payer: First Health Commercial |
$8,721.19
|
| Rate for Payer: Humana Commercial |
$7,803.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,527.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,774.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,078.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,885.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,836.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.86
|
| Rate for Payer: PHCS Commercial |
$8,812.99
|
| Rate for Payer: United Healthcare All Payer |
$8,078.58
|
|
|
TIBIAL AUG NONPOROUS 1*15MM
|
Facility
|
OP
|
$9,180.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.43 |
| Max. Negotiated Rate |
$8,812.99 |
| Rate for Payer: Aetna Commercial |
$7,068.75
|
| Rate for Payer: Anthem Medicaid |
$3,157.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,160.56
|
| Rate for Payer: Cash Price |
$4,590.10
|
| Rate for Payer: Cigna Commercial |
$7,619.57
|
| Rate for Payer: First Health Commercial |
$8,721.19
|
| Rate for Payer: Humana Commercial |
$7,803.17
|
| Rate for Payer: Humana KY Medicaid |
$3,157.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,527.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,774.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,220.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,078.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,885.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,836.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.86
|
| Rate for Payer: PHCS Commercial |
$8,812.99
|
| Rate for Payer: United Healthcare All Payer |
$8,078.58
|
|
|
TIBIAL AUG NONPOROUS 1*15MM
|
Facility
|
IP
|
$9,180.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.43 |
| Max. Negotiated Rate |
$8,812.99 |
| Rate for Payer: Aetna Commercial |
$7,068.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,160.56
|
| Rate for Payer: Cash Price |
$4,590.10
|
| Rate for Payer: Cigna Commercial |
$7,619.57
|
| Rate for Payer: First Health Commercial |
$8,721.19
|
| Rate for Payer: Humana Commercial |
$7,803.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,527.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,774.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,078.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,885.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,836.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.86
|
| Rate for Payer: PHCS Commercial |
$8,812.99
|
| Rate for Payer: United Healthcare All Payer |
$8,078.58
|
|
|
TIBIAL BASE JRNY UNI SZ1 LM/RL
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ1 LM/RL
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ1 RM/LL
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ1 RM/LL
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ2 LM/RL
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ2 LM/RL
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ2 RM/LL
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ2 RM/LL
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ3 LM/RL
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ3 LM/RL
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ3 RM/LL
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIBIAL BASE JRNY UNI SZ3 RM/LL
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
