|
TIBIAL INSERT S 23MM
|
Facility
|
IP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
TIBIAL INSERT S 23MM
|
Facility
|
OP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem Medicaid |
$7,926.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Humana KY Medicaid |
$7,926.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,007.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,085.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
TIBIAL INSRT HINGE UNI SM 18MM
|
Facility
|
IP
|
$21,060.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,737.90 |
| Max. Negotiated Rate |
$20,218.32 |
| Rate for Payer: Aetna Commercial |
$16,216.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,427.38
|
| Rate for Payer: Cash Price |
$10,530.38
|
| Rate for Payer: Cigna Commercial |
$17,480.42
|
| Rate for Payer: First Health Commercial |
$20,007.71
|
| Rate for Payer: Humana Commercial |
$17,901.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,269.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,542.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,318.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,533.46
|
| Rate for Payer: Ohio Health Group HMO |
$15,795.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,212.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,737.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,528.83
|
| Rate for Payer: PHCS Commercial |
$20,218.32
|
| Rate for Payer: United Healthcare All Payer |
$18,533.46
|
|
|
TIBIAL INSRT HINGE UNI SM 18MM
|
Facility
|
OP
|
$21,060.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,737.90 |
| Max. Negotiated Rate |
$20,218.32 |
| Rate for Payer: Aetna Commercial |
$16,216.78
|
| Rate for Payer: Anthem Medicaid |
$7,242.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,427.38
|
| Rate for Payer: Cash Price |
$10,530.38
|
| Rate for Payer: Cigna Commercial |
$17,480.42
|
| Rate for Payer: First Health Commercial |
$20,007.71
|
| Rate for Payer: Humana Commercial |
$17,901.64
|
| Rate for Payer: Humana KY Medicaid |
$7,242.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,316.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,269.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,542.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,318.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,388.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,533.46
|
| Rate for Payer: Ohio Health Group HMO |
$15,795.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,212.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,737.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,528.83
|
| Rate for Payer: PHCS Commercial |
$20,218.32
|
| Rate for Payer: United Healthcare All Payer |
$18,533.46
|
|
|
TIBIAL INSRT PFC SZ2.5 10.0MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSRT PFC SZ2.5 10.0MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSRT PFC SZ2.5 12.5MM
|
Facility
|
IP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL INSRT PFC SZ2.5 12.5MM
|
Facility
|
OP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem Medicaid |
$2,523.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Humana KY Medicaid |
$2,523.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,574.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL INSRT PFC SZ2.5 17.5MM
|
Facility
|
IP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL INSRT PFC SZ2.5 17.5MM
|
Facility
|
OP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem Medicaid |
$2,523.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Humana KY Medicaid |
$2,523.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,574.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL JIG HEAD LEFT MD
|
Facility
|
OP
|
$11,585.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.12 |
| Max. Negotiated Rate |
$11,122.08 |
| Rate for Payer: Aetna Commercial |
$8,920.84
|
| Rate for Payer: Anthem Medicaid |
$3,984.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,036.69
|
| Rate for Payer: Cash Price |
$5,792.75
|
| Rate for Payer: Cigna Commercial |
$9,615.96
|
| Rate for Payer: First Health Commercial |
$11,006.22
|
| Rate for Payer: Humana Commercial |
$9,847.68
|
| Rate for Payer: Humana KY Medicaid |
$3,984.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,500.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,550.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,475.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,064.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,195.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,689.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,317.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,591.50
|
| Rate for Payer: PHCS Commercial |
$11,122.08
|
| Rate for Payer: United Healthcare All Payer |
$10,195.24
|
|
|
TIBIAL JIG HEAD LEFT MD
|
Facility
|
IP
|
$11,585.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.12 |
| Max. Negotiated Rate |
$11,122.08 |
| Rate for Payer: Aetna Commercial |
$8,920.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,036.69
|
| Rate for Payer: Cash Price |
$5,792.75
|
| Rate for Payer: Cigna Commercial |
$9,615.96
|
| Rate for Payer: First Health Commercial |
$11,006.22
|
| Rate for Payer: Humana Commercial |
$9,847.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,500.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,550.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,475.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,195.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,689.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,317.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,591.50
|
| Rate for Payer: PHCS Commercial |
$11,122.08
|
| Rate for Payer: United Healthcare All Payer |
$10,195.24
|
|
|
TIBIAL JIG HEAD RIGHT MD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIBIAL JIG HEAD RIGHT MD
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIBIAL JIG TAIL LEFT MD
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
TIBIAL JIG TAIL LEFT MD
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
TIBIAL JIG TAIL RIGHT MD
|
Facility
|
IP
|
$5,630.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.90 |
| Max. Negotiated Rate |
$5,404.80 |
| Rate for Payer: Aetna Commercial |
$4,335.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,391.40
|
| Rate for Payer: Cash Price |
$2,815.00
|
| Rate for Payer: Cigna Commercial |
$4,672.90
|
| Rate for Payer: First Health Commercial |
$5,348.50
|
| Rate for Payer: Humana Commercial |
$4,785.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,616.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,954.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,745.30
|
| Rate for Payer: PHCS Commercial |
$5,404.80
|
| Rate for Payer: United Healthcare All Payer |
$4,954.40
|
|
|
TIBIAL JIG TAIL RIGHT MD
|
Facility
|
OP
|
$5,630.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.90 |
| Max. Negotiated Rate |
$5,404.80 |
| Rate for Payer: Aetna Commercial |
$4,335.10
|
| Rate for Payer: Anthem Medicaid |
$1,936.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,391.40
|
| Rate for Payer: Cash Price |
$2,815.00
|
| Rate for Payer: Cigna Commercial |
$4,672.90
|
| Rate for Payer: First Health Commercial |
$5,348.50
|
| Rate for Payer: Humana Commercial |
$4,785.50
|
| Rate for Payer: Humana KY Medicaid |
$1,936.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,955.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,616.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,954.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,745.30
|
| Rate for Payer: PHCS Commercial |
$5,404.80
|
| Rate for Payer: United Healthcare All Payer |
$4,954.40
|
|
|
TIBIAL MAX PRDCM BRNG 10*71/75
|
Facility
|
IP
|
$5,539.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.07 |
| Max. Negotiated Rate |
$5,317.44 |
| Rate for Payer: Aetna Commercial |
$4,265.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,320.42
|
| Rate for Payer: Cash Price |
$2,769.50
|
| Rate for Payer: Cigna Commercial |
$4,597.37
|
| Rate for Payer: First Health Commercial |
$5,262.05
|
| Rate for Payer: Humana Commercial |
$4,708.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,717.09
|
| Rate for Payer: PHCS Commercial |
$5,317.44
|
| Rate for Payer: United Healthcare All Payer |
$4,874.32
|
|
|
TIBIAL MAX PRDCM BRNG 10*71/75
|
Facility
|
OP
|
$5,539.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.07 |
| Max. Negotiated Rate |
$5,317.44 |
| Rate for Payer: Aetna Commercial |
$4,265.03
|
| Rate for Payer: Anthem Medicaid |
$1,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,320.42
|
| Rate for Payer: Cash Price |
$2,769.50
|
| Rate for Payer: Cigna Commercial |
$4,597.37
|
| Rate for Payer: First Health Commercial |
$5,262.05
|
| Rate for Payer: Humana Commercial |
$4,708.15
|
| Rate for Payer: Humana KY Medicaid |
$1,904.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,924.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,943.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,717.09
|
| Rate for Payer: PHCS Commercial |
$5,317.44
|
| Rate for Payer: United Healthcare All Payer |
$4,874.32
|
|
|
TIBIAL MAX PRDCM BRNG 12*71/75
|
Facility
|
IP
|
$5,539.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.07 |
| Max. Negotiated Rate |
$5,317.44 |
| Rate for Payer: Aetna Commercial |
$4,265.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,320.42
|
| Rate for Payer: Cash Price |
$2,769.50
|
| Rate for Payer: Cigna Commercial |
$4,597.37
|
| Rate for Payer: First Health Commercial |
$5,262.05
|
| Rate for Payer: Humana Commercial |
$4,708.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,717.09
|
| Rate for Payer: PHCS Commercial |
$5,317.44
|
| Rate for Payer: United Healthcare All Payer |
$4,874.32
|
|
|
TIBIAL MAX PRDCM BRNG 12*71/75
|
Facility
|
OP
|
$5,539.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.07 |
| Max. Negotiated Rate |
$5,317.44 |
| Rate for Payer: Aetna Commercial |
$4,265.03
|
| Rate for Payer: Anthem Medicaid |
$1,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,320.42
|
| Rate for Payer: Cash Price |
$2,769.50
|
| Rate for Payer: Cigna Commercial |
$4,597.37
|
| Rate for Payer: First Health Commercial |
$5,262.05
|
| Rate for Payer: Humana Commercial |
$4,708.15
|
| Rate for Payer: Humana KY Medicaid |
$1,904.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,924.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,943.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,717.09
|
| Rate for Payer: PHCS Commercial |
$5,317.44
|
| Rate for Payer: United Healthcare All Payer |
$4,874.32
|
|
|
TIBIAL MAX PRDCM BRNG 14*63/67
|
Facility
|
IP
|
$5,539.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.07 |
| Max. Negotiated Rate |
$5,317.44 |
| Rate for Payer: Aetna Commercial |
$4,265.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,320.42
|
| Rate for Payer: Cash Price |
$2,769.50
|
| Rate for Payer: Cigna Commercial |
$4,597.37
|
| Rate for Payer: First Health Commercial |
$5,262.05
|
| Rate for Payer: Humana Commercial |
$4,708.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,717.09
|
| Rate for Payer: PHCS Commercial |
$5,317.44
|
| Rate for Payer: United Healthcare All Payer |
$4,874.32
|
|
|
TIBIAL MAX PRDCM BRNG 14*63/67
|
Facility
|
OP
|
$5,539.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.07 |
| Max. Negotiated Rate |
$5,317.44 |
| Rate for Payer: Aetna Commercial |
$4,265.03
|
| Rate for Payer: Anthem Medicaid |
$1,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,320.42
|
| Rate for Payer: Cash Price |
$2,769.50
|
| Rate for Payer: Cigna Commercial |
$4,597.37
|
| Rate for Payer: First Health Commercial |
$5,262.05
|
| Rate for Payer: Humana Commercial |
$4,708.15
|
| Rate for Payer: Humana KY Medicaid |
$1,904.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,924.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,943.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,717.09
|
| Rate for Payer: PHCS Commercial |
$5,317.44
|
| Rate for Payer: United Healthcare All Payer |
$4,874.32
|
|
|
TIBIAL MAX PRDCM BRNG 16*71/75
|
Facility
|
IP
|
$5,539.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.07 |
| Max. Negotiated Rate |
$5,317.44 |
| Rate for Payer: Aetna Commercial |
$4,265.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,320.42
|
| Rate for Payer: Cash Price |
$2,769.50
|
| Rate for Payer: Cigna Commercial |
$4,597.37
|
| Rate for Payer: First Health Commercial |
$5,262.05
|
| Rate for Payer: Humana Commercial |
$4,708.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,717.09
|
| Rate for Payer: PHCS Commercial |
$5,317.44
|
| Rate for Payer: United Healthcare All Payer |
$4,874.32
|
|
