|
TIBIAL COMP OSS AVL MOD PLT 75
|
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 75
|
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 COMP OSSAVL PLY BUSH ST
|
Facility
|
OP
|
$4,182.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.71 |
| Max. Negotiated Rate |
$4,015.10 |
| Rate for Payer: Aetna Commercial |
$3,220.45
|
| Rate for Payer: Anthem Medicaid |
$1,438.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,262.27
|
| Rate for Payer: Cash Price |
$2,091.20
|
| Rate for Payer: Cigna Commercial |
$3,471.39
|
| Rate for Payer: First Health Commercial |
$3,973.28
|
| Rate for Payer: Humana Commercial |
$3,555.04
|
| Rate for Payer: Humana KY Medicaid |
$1,438.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,452.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,429.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,086.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,467.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,680.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,296.54
|
| Rate for Payer: PHCS Commercial |
$4,015.10
|
| Rate for Payer: United Healthcare All Payer |
$3,680.51
|
|
|
TIBIAL COMP OSSAVL PLY BUSH ST
|
Facility
|
IP
|
$4,182.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.71 |
| Max. Negotiated Rate |
$4,015.10 |
| Rate for Payer: Aetna Commercial |
$3,220.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,262.27
|
| Rate for Payer: Cash Price |
$2,091.20
|
| Rate for Payer: Cigna Commercial |
$3,471.39
|
| Rate for Payer: First Health Commercial |
$3,973.28
|
| Rate for Payer: Humana Commercial |
$3,555.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,429.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,086.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,680.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,296.54
|
| Rate for Payer: PHCS Commercial |
$4,015.10
|
| Rate for Payer: United Healthcare All Payer |
$3,680.51
|
|
|
TIBIAL COMP OSS AVL TAP 63 LNG
|
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 COMP OSS AVL TAP 63 LNG
|
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 COMP OSS AVL TAPE 79
|
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 TAPE 79
|
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 COMP OSS AVL TAPE 83
|
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 TAPE 83
|
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 COMP OSS AVL YOKE 12MM
|
Facility
|
IP
|
$8,415.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.97 |
| Max. Negotiated Rate |
$8,078.55 |
| Rate for Payer: Aetna Commercial |
$6,479.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.82
|
| Rate for Payer: Cash Price |
$4,207.58
|
| Rate for Payer: Cigna Commercial |
$6,984.58
|
| Rate for Payer: First Health Commercial |
$7,994.40
|
| Rate for Payer: Humana Commercial |
$7,152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.70
|
| Rate for Payer: PHCS Commercial |
$8,078.55
|
| Rate for Payer: United Healthcare All Payer |
$7,405.34
|
|
|
TIBIAL COMP OSS AVL YOKE 12MM
|
Facility
|
OP
|
$8,415.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.97 |
| Max. Negotiated Rate |
$8,078.55 |
| Rate for Payer: Aetna Commercial |
$6,479.67
|
| Rate for Payer: Anthem Medicaid |
$2,893.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.82
|
| Rate for Payer: Cash Price |
$4,207.58
|
| Rate for Payer: Cigna Commercial |
$6,984.58
|
| Rate for Payer: First Health Commercial |
$7,994.40
|
| Rate for Payer: Humana Commercial |
$7,152.89
|
| Rate for Payer: Humana KY Medicaid |
$2,893.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.70
|
| Rate for Payer: PHCS Commercial |
$8,078.55
|
| Rate for Payer: United Healthcare All Payer |
$7,405.34
|
|
|
TIBIAL COMP OSS AVL YOKE 14MM
|
Facility
|
OP
|
$8,415.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.97 |
| Max. Negotiated Rate |
$8,078.55 |
| Rate for Payer: Aetna Commercial |
$6,479.67
|
| Rate for Payer: Anthem Medicaid |
$2,893.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.82
|
| Rate for Payer: Cash Price |
$4,207.58
|
| Rate for Payer: Cigna Commercial |
$6,984.58
|
| Rate for Payer: First Health Commercial |
$7,994.40
|
| Rate for Payer: Humana Commercial |
$7,152.89
|
| Rate for Payer: Humana KY Medicaid |
$2,893.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.70
|
| Rate for Payer: PHCS Commercial |
$8,078.55
|
| Rate for Payer: United Healthcare All Payer |
$7,405.34
|
|
|
TIBIAL COMP OSS AVL YOKE 14MM
|
Facility
|
IP
|
$8,415.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.97 |
| Max. Negotiated Rate |
$8,078.55 |
| Rate for Payer: Aetna Commercial |
$6,479.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.82
|
| Rate for Payer: Cash Price |
$4,207.58
|
| Rate for Payer: Cigna Commercial |
$6,984.58
|
| Rate for Payer: First Health Commercial |
$7,994.40
|
| Rate for Payer: Humana Commercial |
$7,152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.70
|
| Rate for Payer: PHCS Commercial |
$8,078.55
|
| Rate for Payer: United Healthcare All Payer |
$7,405.34
|
|
|
TIBIAL COMP OSS AVL YOKE 16MM
|
Facility
|
OP
|
$8,415.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.97 |
| Max. Negotiated Rate |
$8,078.55 |
| Rate for Payer: Aetna Commercial |
$6,479.67
|
| Rate for Payer: Anthem Medicaid |
$2,893.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.82
|
| Rate for Payer: Cash Price |
$4,207.58
|
| Rate for Payer: Cigna Commercial |
$6,984.58
|
| Rate for Payer: First Health Commercial |
$7,994.40
|
| Rate for Payer: Humana Commercial |
$7,152.89
|
| Rate for Payer: Humana KY Medicaid |
$2,893.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.70
|
| Rate for Payer: PHCS Commercial |
$8,078.55
|
| Rate for Payer: United Healthcare All Payer |
$7,405.34
|
|
|
TIBIAL COMP OSS AVL YOKE 16MM
|
Facility
|
IP
|
$8,415.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.97 |
| Max. Negotiated Rate |
$8,078.55 |
| Rate for Payer: Aetna Commercial |
$6,479.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.82
|
| Rate for Payer: Cash Price |
$4,207.58
|
| Rate for Payer: Cigna Commercial |
$6,984.58
|
| Rate for Payer: First Health Commercial |
$7,994.40
|
| Rate for Payer: Humana Commercial |
$7,152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.70
|
| Rate for Payer: PHCS Commercial |
$8,078.55
|
| Rate for Payer: United Healthcare All Payer |
$7,405.34
|
|
|
TIBIAL COMP OSS HYBRD PLY 51MM
|
Facility
|
OP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem Medicaid |
$9,298.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Humana KY Medicaid |
$9,298.11
|
| Rate for Payer: Kentucky WC Medicaid |
$9,392.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,484.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 51MM
|
Facility
|
IP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 55MM
|
Facility
|
OP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem Medicaid |
$9,298.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Humana KY Medicaid |
$9,298.11
|
| Rate for Payer: Kentucky WC Medicaid |
$9,392.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,484.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 55MM
|
Facility
|
IP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 59MM
|
Facility
|
IP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 59MM
|
Facility
|
OP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem Medicaid |
$9,298.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Humana KY Medicaid |
$9,298.11
|
| Rate for Payer: Kentucky WC Medicaid |
$9,392.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,484.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 63MM
|
Facility
|
IP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 63MM
|
Facility
|
OP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem Medicaid |
$9,298.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Humana KY Medicaid |
$9,298.11
|
| Rate for Payer: Kentucky WC Medicaid |
$9,392.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,484.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS HYBRD PLY 67MM
|
Facility
|
OP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem Medicaid |
$9,298.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Humana KY Medicaid |
$9,298.11
|
| Rate for Payer: Kentucky WC Medicaid |
$9,392.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,484.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
