|
TIBIAL INSERT FLEX PS #11 8
|
Facility
|
IP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #11 8
|
Facility
|
OP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem Medicaid |
$2,596.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Humana KY Medicaid |
$2,596.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,623.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,648.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #3 10
|
Facility
|
IP
|
$7,758.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.56 |
| Max. Negotiated Rate |
$7,447.83 |
| Rate for Payer: Aetna Commercial |
$5,973.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,051.36
|
| Rate for Payer: Cash Price |
$3,879.08
|
| Rate for Payer: Cigna Commercial |
$6,439.27
|
| Rate for Payer: First Health Commercial |
$7,370.25
|
| Rate for Payer: Humana Commercial |
$6,594.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,725.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,827.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,551.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.03
|
| Rate for Payer: PHCS Commercial |
$7,447.83
|
| Rate for Payer: United Healthcare All Payer |
$6,827.18
|
|
|
TIBIAL INSERT FLEX PS #3 10
|
Facility
|
OP
|
$7,758.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.56 |
| Max. Negotiated Rate |
$7,447.83 |
| Rate for Payer: Aetna Commercial |
$5,973.78
|
| Rate for Payer: Anthem Medicaid |
$2,668.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,051.36
|
| Rate for Payer: Cash Price |
$3,879.08
|
| Rate for Payer: Cigna Commercial |
$6,439.27
|
| Rate for Payer: First Health Commercial |
$7,370.25
|
| Rate for Payer: Humana Commercial |
$6,594.44
|
| Rate for Payer: Humana KY Medicaid |
$2,668.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,695.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,725.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,721.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,827.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,551.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.03
|
| Rate for Payer: PHCS Commercial |
$7,447.83
|
| Rate for Payer: United Healthcare All Payer |
$6,827.18
|
|
|
TIBIAL INSERT FLEX PS #3 12
|
Facility
|
OP
|
$7,279.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.31 |
| Max. Negotiated Rate |
$6,988.11 |
| Rate for Payer: Aetna Commercial |
$5,605.05
|
| Rate for Payer: Anthem Medicaid |
$2,503.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,677.84
|
| Rate for Payer: Cash Price |
$3,639.64
|
| Rate for Payer: Cigna Commercial |
$6,041.80
|
| Rate for Payer: First Health Commercial |
$6,915.32
|
| Rate for Payer: Humana Commercial |
$6,187.39
|
| Rate for Payer: Humana KY Medicaid |
$2,503.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,528.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,969.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,372.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,553.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,405.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.58
|
| Rate for Payer: PHCS Commercial |
$6,988.11
|
| Rate for Payer: United Healthcare All Payer |
$6,405.77
|
|
|
TIBIAL INSERT FLEX PS #3 12
|
Facility
|
IP
|
$7,279.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.31 |
| Max. Negotiated Rate |
$6,988.11 |
| Rate for Payer: Aetna Commercial |
$5,605.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,677.84
|
| Rate for Payer: Cash Price |
$3,639.64
|
| Rate for Payer: Cigna Commercial |
$6,041.80
|
| Rate for Payer: First Health Commercial |
$6,915.32
|
| Rate for Payer: Humana Commercial |
$6,187.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,969.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,372.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,405.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,459.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.58
|
| Rate for Payer: PHCS Commercial |
$6,988.11
|
| Rate for Payer: United Healthcare All Payer |
$6,405.77
|
|
|
TIBIAL INSERT FLEX PS #3 15
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 15
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 18
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 18
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 21
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 21
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 24
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 24
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #3 8
|
Facility
|
IP
|
$7,022.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.90 |
| Max. Negotiated Rate |
$6,741.43 |
| Rate for Payer: Aetna Commercial |
$5,407.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,477.41
|
| Rate for Payer: Cash Price |
$3,511.16
|
| Rate for Payer: Cigna Commercial |
$5,828.53
|
| Rate for Payer: First Health Commercial |
$6,671.20
|
| Rate for Payer: Humana Commercial |
$5,968.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,758.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,182.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,106.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,179.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,266.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,176.92
|
| Rate for Payer: PHCS Commercial |
$6,741.43
|
| Rate for Payer: United Healthcare All Payer |
$6,179.64
|
|
|
TIBIAL INSERT FLEX PS #3 8
|
Facility
|
OP
|
$7,022.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.90 |
| Max. Negotiated Rate |
$6,741.43 |
| Rate for Payer: Aetna Commercial |
$5,407.19
|
| Rate for Payer: Anthem Medicaid |
$2,414.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,477.41
|
| Rate for Payer: Cash Price |
$3,511.16
|
| Rate for Payer: Cigna Commercial |
$5,828.53
|
| Rate for Payer: First Health Commercial |
$6,671.20
|
| Rate for Payer: Humana Commercial |
$5,968.97
|
| Rate for Payer: Humana KY Medicaid |
$2,414.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,439.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,758.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,182.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,106.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,463.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,179.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,266.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,176.92
|
| Rate for Payer: PHCS Commercial |
$6,741.43
|
| Rate for Payer: United Healthcare All Payer |
$6,179.64
|
|
|
TIBIAL INSERT FLEX PS #5 10
|
Facility
|
IP
|
$7,883.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.88 |
| Max. Negotiated Rate |
$7,568.37 |
| Rate for Payer: Aetna Commercial |
$6,070.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.30
|
| Rate for Payer: Cash Price |
$3,941.86
|
| Rate for Payer: Cigna Commercial |
$6,543.49
|
| Rate for Payer: First Health Commercial |
$7,489.53
|
| Rate for Payer: Humana Commercial |
$6,701.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,443.95
|
| Rate for Payer: PHCS Commercial |
$7,568.37
|
| Rate for Payer: United Healthcare All Payer |
$6,937.67
|
|
|
TIBIAL INSERT FLEX PS #5 10
|
Facility
|
OP
|
$7,883.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.88 |
| Max. Negotiated Rate |
$7,568.37 |
| Rate for Payer: Aetna Commercial |
$6,070.46
|
| Rate for Payer: Anthem Medicaid |
$2,711.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.30
|
| Rate for Payer: Cash Price |
$3,941.86
|
| Rate for Payer: Cigna Commercial |
$6,543.49
|
| Rate for Payer: First Health Commercial |
$7,489.53
|
| Rate for Payer: Humana Commercial |
$6,701.16
|
| Rate for Payer: Humana KY Medicaid |
$2,711.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,443.95
|
| Rate for Payer: PHCS Commercial |
$7,568.37
|
| Rate for Payer: United Healthcare All Payer |
$6,937.67
|
|
|
TIBIAL INSERT FLEX PS #5 12
|
Facility
|
IP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #5 12
|
Facility
|
OP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem Medicaid |
$2,596.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Humana KY Medicaid |
$2,596.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,623.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,648.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #5 15
|
Facility
|
OP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem Medicaid |
$2,596.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Humana KY Medicaid |
$2,596.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,623.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,648.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #5 15
|
Facility
|
IP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #5 18
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #5 18
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #5 21
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
