|
TIBIAL CEM MBT REV SZ 4
|
Facility
|
OP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem Medicaid |
$11,128.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Humana KY Medicaid |
$11,128.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 5
|
Facility
|
OP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem Medicaid |
$11,128.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Humana KY Medicaid |
$11,128.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 5
|
Facility
|
IP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 6
|
Facility
|
OP
|
$37,222.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.98 |
| Max. Negotiated Rate |
$35,734.03 |
| Rate for Payer: Aetna Commercial |
$28,661.67
|
| Rate for Payer: Anthem Medicaid |
$12,800.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,033.90
|
| Rate for Payer: Cash Price |
$18,611.47
|
| Rate for Payer: Cigna Commercial |
$30,895.05
|
| Rate for Payer: First Health Commercial |
$35,361.80
|
| Rate for Payer: Humana Commercial |
$31,639.51
|
| Rate for Payer: Humana KY Medicaid |
$12,800.97
|
| Rate for Payer: Kentucky WC Medicaid |
$12,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,522.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,470.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,166.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,057.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,756.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,917.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,444.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,838.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,539.11
|
| Rate for Payer: PHCS Commercial |
$35,734.03
|
| Rate for Payer: United Healthcare All Payer |
$32,756.20
|
|
|
TIBIAL CEM MBT REV SZ 6
|
Facility
|
IP
|
$37,222.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.98 |
| Max. Negotiated Rate |
$35,734.03 |
| Rate for Payer: Aetna Commercial |
$28,661.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,033.90
|
| Rate for Payer: Cash Price |
$18,611.47
|
| Rate for Payer: Cigna Commercial |
$30,895.05
|
| Rate for Payer: First Health Commercial |
$35,361.80
|
| Rate for Payer: Humana Commercial |
$31,639.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,522.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,470.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,166.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,756.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,917.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,444.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,838.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,539.11
|
| Rate for Payer: PHCS Commercial |
$35,734.03
|
| Rate for Payer: United Healthcare All Payer |
$32,756.20
|
|
|
TIBIAL CMP OSSAVL MOD PLT TPE
|
Facility
|
IP
|
$26,511.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,446.52 |
| Max. Negotiated Rate |
$25,451.19 |
| Rate for Payer: Aetna Commercial |
$20,413.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,679.09
|
| Rate for Payer: Cash Price |
$13,255.83
|
| Rate for Payer: Cigna Commercial |
$22,004.68
|
| Rate for Payer: First Health Commercial |
$25,186.08
|
| Rate for Payer: Humana Commercial |
$22,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,739.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,565.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,953.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,330.26
|
| Rate for Payer: Ohio Health Group HMO |
$19,883.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,302.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,446.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,218.61
|
| Rate for Payer: PHCS Commercial |
$25,451.19
|
| Rate for Payer: United Healthcare All Payer |
$23,330.26
|
|
|
TIBIAL CMP OSSAVL MOD PLT TPE
|
Facility
|
OP
|
$26,511.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,446.52 |
| Max. Negotiated Rate |
$25,451.19 |
| Rate for Payer: Aetna Commercial |
$20,413.98
|
| Rate for Payer: Anthem Medicaid |
$9,117.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,679.09
|
| Rate for Payer: Cash Price |
$13,255.83
|
| Rate for Payer: Cigna Commercial |
$22,004.68
|
| Rate for Payer: First Health Commercial |
$25,186.08
|
| Rate for Payer: Humana Commercial |
$22,534.91
|
| Rate for Payer: Humana KY Medicaid |
$9,117.36
|
| Rate for Payer: Kentucky WC Medicaid |
$9,210.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,739.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,565.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,953.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,300.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,330.26
|
| Rate for Payer: Ohio Health Group HMO |
$19,883.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,302.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,446.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,218.61
|
| Rate for Payer: PHCS Commercial |
$25,451.19
|
| Rate for Payer: United Healthcare All Payer |
$23,330.26
|
|
|
TIBIAL CMP OSSAVL NONMOD 67 LG
|
Facility
|
OP
|
$26,117.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,395.27 |
| Max. Negotiated Rate |
$25,072.76 |
| Rate for Payer: Aetna Commercial |
$20,110.44
|
| Rate for Payer: Anthem Medicaid |
$8,981.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,371.62
|
| Rate for Payer: Cash Price |
$13,058.73
|
| Rate for Payer: Cigna Commercial |
$21,677.49
|
| Rate for Payer: First Health Commercial |
$24,811.59
|
| Rate for Payer: Humana Commercial |
$22,199.84
|
| Rate for Payer: Humana KY Medicaid |
$8,981.79
|
| Rate for Payer: Kentucky WC Medicaid |
$9,073.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,416.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,274.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,835.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,983.36
|
| Rate for Payer: Ohio Health Group HMO |
$19,588.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,223.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,096.41
|
| Rate for Payer: PHCS Commercial |
$25,072.76
|
| Rate for Payer: United Healthcare All Payer |
$22,983.36
|
|
|
TIBIAL CMP OSSAVL NONMOD 67 LG
|
Facility
|
IP
|
$26,117.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,395.27 |
| Max. Negotiated Rate |
$25,072.76 |
| Rate for Payer: Aetna Commercial |
$20,110.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,371.62
|
| Rate for Payer: Cash Price |
$13,058.73
|
| Rate for Payer: Cigna Commercial |
$21,677.49
|
| Rate for Payer: First Health Commercial |
$24,811.59
|
| Rate for Payer: Humana Commercial |
$22,199.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,416.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,274.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,835.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,983.36
|
| Rate for Payer: Ohio Health Group HMO |
$19,588.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,223.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,096.41
|
| Rate for Payer: PHCS Commercial |
$25,072.76
|
| Rate for Payer: United Healthcare All Payer |
$22,983.36
|
|
|
TIBIAL CMP OSSAVL TPE 63 SHRT
|
Facility
|
OP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem Medicaid |
$8,710.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Humana KY Medicaid |
$8,710.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,799.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,885.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL CMP OSSAVL TPE 63 SHRT
|
Facility
|
IP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL CMP OSSAVL TPE 67 SHRT
|
Facility
|
IP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL CMP OSSAVL TPE 67 SHRT
|
Facility
|
OP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem Medicaid |
$8,710.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Humana KY Medicaid |
$8,710.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,799.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,885.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL CMP OSSAVL TPE 71 SHRT
|
Facility
|
IP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL CMP OSSAVL TPE 71 SHRT
|
Facility
|
OP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem Medicaid |
$8,710.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Humana KY Medicaid |
$8,710.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,799.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,885.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL COMP OSSAVL BEARNG 12MM
|
Facility
|
IP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 12MM
|
Facility
|
OP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem Medicaid |
$3,210.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Humana KY Medicaid |
$3,210.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 14MM
|
Facility
|
OP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem Medicaid |
$3,210.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Humana KY Medicaid |
$3,210.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 14MM
|
Facility
|
IP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 16MM
|
Facility
|
OP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem Medicaid |
$3,210.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Humana KY Medicaid |
$3,210.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 16MM
|
Facility
|
IP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL COMP OSS AVL LOCK RING
|
Facility
|
IP
|
$4,531.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.03 |
| Max. Negotiated Rate |
$4,349.76 |
| Rate for Payer: Aetna Commercial |
$3,488.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.18
|
| Rate for Payer: Cash Price |
$2,265.50
|
| Rate for Payer: Cigna Commercial |
$3,760.73
|
| Rate for Payer: First Health Commercial |
$4,304.45
|
| Rate for Payer: Humana Commercial |
$3,851.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,404.61
|
| Rate for Payer: PHCS Commercial |
$4,349.76
|
| Rate for Payer: United Healthcare All Payer |
$3,987.28
|
|
|
TIBIAL COMP OSS AVL LOCK RING
|
Facility
|
OP
|
$4,531.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.03 |
| Max. Negotiated Rate |
$4,349.76 |
| Rate for Payer: Aetna Commercial |
$3,488.87
|
| Rate for Payer: Anthem Medicaid |
$1,558.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.18
|
| Rate for Payer: Cash Price |
$2,265.50
|
| Rate for Payer: Cigna Commercial |
$3,760.73
|
| Rate for Payer: First Health Commercial |
$4,304.45
|
| Rate for Payer: Humana Commercial |
$3,851.35
|
| Rate for Payer: Humana KY Medicaid |
$1,558.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,404.61
|
| Rate for Payer: PHCS Commercial |
$4,349.76
|
| Rate for Payer: United Healthcare All Payer |
$3,987.28
|
|
|
TIBIAL COMP OSS AVL MOD PLT 71
|
Facility
|
IP
|
$26,511.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,446.52 |
| Max. Negotiated Rate |
$25,451.19 |
| Rate for Payer: Aetna Commercial |
$20,413.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,679.09
|
| Rate for Payer: Cash Price |
$13,255.83
|
| Rate for Payer: Cigna Commercial |
$22,004.68
|
| Rate for Payer: First Health Commercial |
$25,186.08
|
| Rate for Payer: Humana Commercial |
$22,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,739.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,565.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,953.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,330.26
|
| Rate for Payer: Ohio Health Group HMO |
$19,883.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,302.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,446.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,218.61
|
| Rate for Payer: PHCS Commercial |
$25,451.19
|
| Rate for Payer: United Healthcare All Payer |
$23,330.26
|
|
|
TIBIAL COMP OSS AVL MOD PLT 71
|
Facility
|
OP
|
$26,511.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,446.52 |
| Max. Negotiated Rate |
$25,451.19 |
| Rate for Payer: Aetna Commercial |
$20,413.98
|
| Rate for Payer: Anthem Medicaid |
$9,117.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,679.09
|
| Rate for Payer: Cash Price |
$13,255.83
|
| Rate for Payer: Cigna Commercial |
$22,004.68
|
| Rate for Payer: First Health Commercial |
$25,186.08
|
| Rate for Payer: Humana Commercial |
$22,534.91
|
| Rate for Payer: Humana KY Medicaid |
$9,117.36
|
| Rate for Payer: Kentucky WC Medicaid |
$9,210.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,739.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,565.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,953.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,300.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,330.26
|
| Rate for Payer: Ohio Health Group HMO |
$19,883.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,302.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,446.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,218.61
|
| Rate for Payer: PHCS Commercial |
$25,451.19
|
| Rate for Payer: United Healthcare All Payer |
$23,330.26
|
|
