|
TIBIAL BASE PLAT OSS RS LNG 51
|
Facility
|
IP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 51
|
Facility
|
OP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem Medicaid |
$8,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Humana KY Medicaid |
$8,552.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 55
|
Facility
|
OP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem Medicaid |
$8,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Humana KY Medicaid |
$8,552.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 55
|
Facility
|
IP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 59
|
Facility
|
OP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem Medicaid |
$8,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Humana KY Medicaid |
$8,552.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 59
|
Facility
|
IP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 63
|
Facility
|
OP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem Medicaid |
$8,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Humana KY Medicaid |
$8,552.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 63
|
Facility
|
IP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 67
|
Facility
|
OP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem Medicaid |
$8,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Humana KY Medicaid |
$8,552.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 67
|
Facility
|
IP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 71
|
Facility
|
OP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem Medicaid |
$8,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Humana KY Medicaid |
$8,552.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 71
|
Facility
|
IP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS SHT 47
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 47
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 51
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 51
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 55
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 55
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 59
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 59
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 63
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 63
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 67
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 67
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLAT OSS RS SHT 71
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
