|
TIBIAL MAX PRDCM BRNG 16*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 18*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 18*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 MBT CEMT SZ 3
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL MBT CEMT SZ 3
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL MBTTHK TRY REV CEM 3*15
|
Facility
|
IP
|
$80,900.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,517.10 |
| Max. Negotiated Rate |
$77,664.77 |
| Rate for Payer: Aetna Commercial |
$62,293.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,102.62
|
| Rate for Payer: Cash Price |
$40,450.40
|
| Rate for Payer: Cigna Commercial |
$67,147.66
|
| Rate for Payer: First Health Commercial |
$76,855.76
|
| Rate for Payer: Humana Commercial |
$68,765.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,270.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,192.70
|
| Rate for Payer: Ohio Health Group HMO |
$60,675.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,180.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,517.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,079.25
|
| Rate for Payer: PHCS Commercial |
$77,664.77
|
| Rate for Payer: United Healthcare All Payer |
$71,192.70
|
|
|
TIBIAL MBTTHK TRY REV CEM 3*15
|
Facility
|
OP
|
$80,900.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,517.10 |
| Max. Negotiated Rate |
$77,664.77 |
| Rate for Payer: Aetna Commercial |
$62,293.62
|
| Rate for Payer: Anthem Medicaid |
$27,821.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,102.62
|
| Rate for Payer: Cash Price |
$40,450.40
|
| Rate for Payer: Cigna Commercial |
$67,147.66
|
| Rate for Payer: First Health Commercial |
$76,855.76
|
| Rate for Payer: Humana Commercial |
$68,765.68
|
| Rate for Payer: Humana KY Medicaid |
$27,821.79
|
| Rate for Payer: Kentucky WC Medicaid |
$28,104.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,270.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,380.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,192.70
|
| Rate for Payer: Ohio Health Group HMO |
$60,675.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,180.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,517.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,079.25
|
| Rate for Payer: PHCS Commercial |
$77,664.77
|
| Rate for Payer: United Healthcare All Payer |
$71,192.70
|
|
|
TIBIAL MBT THKTRY REV CEM 4*15
|
Facility
|
IP
|
$80,897.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,516.64 |
| Max. Negotiated Rate |
$77,661.31 |
| Rate for Payer: Aetna Commercial |
$62,290.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,099.82
|
| Rate for Payer: Cash Price |
$40,448.60
|
| Rate for Payer: Cigna Commercial |
$67,144.68
|
| Rate for Payer: First Health Commercial |
$76,852.34
|
| Rate for Payer: Humana Commercial |
$68,762.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,335.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,702.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,269.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,189.54
|
| Rate for Payer: Ohio Health Group HMO |
$60,672.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,179.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,078.13
|
| Rate for Payer: PHCS Commercial |
$77,661.31
|
| Rate for Payer: United Healthcare All Payer |
$71,189.54
|
|
|
TIBIAL MBT THKTRY REV CEM 4*15
|
Facility
|
OP
|
$80,897.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,516.64 |
| Max. Negotiated Rate |
$77,661.31 |
| Rate for Payer: Aetna Commercial |
$62,290.84
|
| Rate for Payer: Anthem Medicaid |
$27,820.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,099.82
|
| Rate for Payer: Cash Price |
$40,448.60
|
| Rate for Payer: Cigna Commercial |
$67,144.68
|
| Rate for Payer: First Health Commercial |
$76,852.34
|
| Rate for Payer: Humana Commercial |
$68,762.62
|
| Rate for Payer: Humana KY Medicaid |
$27,820.55
|
| Rate for Payer: Kentucky WC Medicaid |
$28,103.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,335.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,702.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,269.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,378.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,189.54
|
| Rate for Payer: Ohio Health Group HMO |
$60,672.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,179.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,078.13
|
| Rate for Payer: PHCS Commercial |
$77,661.31
|
| Rate for Payer: United Healthcare All Payer |
$71,189.54
|
|
|
TIBIAL PROXOSS 1 PC 5CM 9*150
|
Facility
|
IP
|
$75,667.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,836.82 |
| Max. Negotiated Rate |
$72,641.13 |
| Rate for Payer: Aetna Commercial |
$58,264.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,020.92
|
| Rate for Payer: Cash Price |
$37,833.92
|
| Rate for Payer: Cigna Commercial |
$62,804.31
|
| Rate for Payer: First Health Commercial |
$71,884.45
|
| Rate for Payer: Humana Commercial |
$64,317.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,047.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,842.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,700.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,587.70
|
| Rate for Payer: Ohio Health Group HMO |
$56,750.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,133.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,836.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,457.03
|
| Rate for Payer: PHCS Commercial |
$72,641.13
|
| Rate for Payer: United Healthcare All Payer |
$66,587.70
|
|
|
TIBIAL PROXOSS 1 PC 5CM 9*150
|
Facility
|
OP
|
$75,667.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,836.82 |
| Max. Negotiated Rate |
$72,641.13 |
| Rate for Payer: Aetna Commercial |
$58,264.24
|
| Rate for Payer: Anthem Medicaid |
$26,022.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,020.92
|
| Rate for Payer: Cash Price |
$37,833.92
|
| Rate for Payer: Cigna Commercial |
$62,804.31
|
| Rate for Payer: First Health Commercial |
$71,884.45
|
| Rate for Payer: Humana Commercial |
$64,317.66
|
| Rate for Payer: Humana KY Medicaid |
$26,022.17
|
| Rate for Payer: Kentucky WC Medicaid |
$26,287.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,047.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,842.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,700.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,544.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,587.70
|
| Rate for Payer: Ohio Health Group HMO |
$56,750.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,133.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,836.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,457.03
|
| Rate for Payer: PHCS Commercial |
$72,641.13
|
| Rate for Payer: United Healthcare All Payer |
$66,587.70
|
|
|
TIBIAL PROXOSS 1 PC 7CM 9*150
|
Facility
|
IP
|
$78,713.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,232.75 |
| Max. Negotiated Rate |
$75,564.90 |
| Rate for Payer: Aetna Commercial |
$60,609.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,396.48
|
| Rate for Payer: Cash Price |
$39,356.72
|
| Rate for Payer: Cigna Commercial |
$65,332.16
|
| Rate for Payer: First Health Commercial |
$74,777.77
|
| Rate for Payer: Humana Commercial |
$66,906.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,545.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,090.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,614.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,267.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,035.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,742.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,232.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,401.17
|
| Rate for Payer: PHCS Commercial |
$75,564.90
|
| Rate for Payer: United Healthcare All Payer |
$69,267.83
|
|
|
TIBIAL PROXOSS 1 PC 7CM 9*150
|
Facility
|
OP
|
$78,713.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,232.75 |
| Max. Negotiated Rate |
$75,564.90 |
| Rate for Payer: Aetna Commercial |
$60,609.35
|
| Rate for Payer: Anthem Medicaid |
$27,069.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,396.48
|
| Rate for Payer: Cash Price |
$39,356.72
|
| Rate for Payer: Cigna Commercial |
$65,332.16
|
| Rate for Payer: First Health Commercial |
$74,777.77
|
| Rate for Payer: Humana Commercial |
$66,906.42
|
| Rate for Payer: Humana KY Medicaid |
$27,069.55
|
| Rate for Payer: Kentucky WC Medicaid |
$27,345.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,545.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,090.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,614.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,612.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,267.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,035.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,742.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,232.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,401.17
|
| Rate for Payer: PHCS Commercial |
$75,564.90
|
| Rate for Payer: United Healthcare All Payer |
$69,267.83
|
|
|
TIBIAL ROT PROX SM COMP
|
Facility
|
IP
|
$15,472.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.40 |
| Max. Negotiated Rate |
$14,853.43 |
| Rate for Payer: Aetna Commercial |
$11,913.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,068.41
|
| Rate for Payer: Cash Price |
$7,736.16
|
| Rate for Payer: Cigna Commercial |
$12,842.03
|
| Rate for Payer: First Health Commercial |
$14,698.70
|
| Rate for Payer: Humana Commercial |
$13,151.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,687.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,418.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,641.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,615.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,604.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,094.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,011.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,796.42
|
| Rate for Payer: PHCS Commercial |
$14,853.43
|
| Rate for Payer: United Healthcare All Payer |
$13,615.64
|
|
|
TIBIAL ROT PROX SM COMP
|
Facility
|
OP
|
$15,472.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.40 |
| Max. Negotiated Rate |
$14,853.43 |
| Rate for Payer: Aetna Commercial |
$11,913.69
|
| Rate for Payer: Anthem Medicaid |
$5,320.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,068.41
|
| Rate for Payer: Cash Price |
$7,736.16
|
| Rate for Payer: Cigna Commercial |
$12,842.03
|
| Rate for Payer: First Health Commercial |
$14,698.70
|
| Rate for Payer: Humana Commercial |
$13,151.47
|
| Rate for Payer: Humana KY Medicaid |
$5,320.93
|
| Rate for Payer: Kentucky WC Medicaid |
$5,375.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,687.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,418.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,641.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,427.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,615.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,604.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,094.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,011.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,796.42
|
| Rate for Payer: PHCS Commercial |
$14,853.43
|
| Rate for Payer: United Healthcare All Payer |
$13,615.64
|
|
|
TIBIAL SLEEVE OSS PROX 3CM
|
Facility
|
IP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
TIBIAL SLEEVE OSS PROX 3CM
|
Facility
|
OP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem Medicaid |
$5,901.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Humana KY Medicaid |
$5,901.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
TIBIAL SLEEVE OSS PROX 5CM
|
Facility
|
OP
|
$24,474.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,181.74 |
| Max. Negotiated Rate |
$23,495.96 |
| Rate for Payer: Aetna Commercial |
$18,845.72
|
| Rate for Payer: Anthem Medicaid |
$8,416.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,090.47
|
| Rate for Payer: Cash Price |
$12,237.48
|
| Rate for Payer: Cigna Commercial |
$20,314.22
|
| Rate for Payer: First Health Commercial |
$23,251.21
|
| Rate for Payer: Humana Commercial |
$20,803.72
|
| Rate for Payer: Humana KY Medicaid |
$8,416.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,502.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,069.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,062.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,342.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,585.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,537.96
|
| Rate for Payer: Ohio Health Group HMO |
$18,356.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,894.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,181.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,587.24
|
| Rate for Payer: PHCS Commercial |
$23,495.96
|
| Rate for Payer: United Healthcare All Payer |
$21,537.96
|
|
|
TIBIAL SLEEVE OSS PROX 5CM
|
Facility
|
IP
|
$24,474.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,181.74 |
| Max. Negotiated Rate |
$23,495.96 |
| Rate for Payer: Aetna Commercial |
$18,845.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,090.47
|
| Rate for Payer: Cash Price |
$12,237.48
|
| Rate for Payer: Cigna Commercial |
$20,314.22
|
| Rate for Payer: First Health Commercial |
$23,251.21
|
| Rate for Payer: Humana Commercial |
$20,803.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,069.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,062.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,342.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,537.96
|
| Rate for Payer: Ohio Health Group HMO |
$18,356.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,894.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,181.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,587.24
|
| Rate for Payer: PHCS Commercial |
$23,495.96
|
| Rate for Payer: United Healthcare All Payer |
$21,537.96
|
|
|
TIBIAL SLEEVE OSS PROX 7CM
|
Facility
|
OP
|
$31,044.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,035.84 |
| Max. Negotiated Rate |
$29,803.16 |
| Rate for Payer: Aetna Commercial |
$23,904.62
|
| Rate for Payer: Anthem Medicaid |
$10,676.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,215.07
|
| Rate for Payer: Cash Price |
$15,522.48
|
| Rate for Payer: Cigna Commercial |
$25,767.32
|
| Rate for Payer: First Health Commercial |
$29,492.71
|
| Rate for Payer: Humana Commercial |
$26,388.22
|
| Rate for Payer: Humana KY Medicaid |
$10,676.36
|
| Rate for Payer: Kentucky WC Medicaid |
$10,785.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,456.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,911.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,313.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,890.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,319.56
|
| Rate for Payer: Ohio Health Group HMO |
$23,283.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,208.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,035.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,623.94
|
| Rate for Payer: PHCS Commercial |
$29,803.16
|
| Rate for Payer: United Healthcare All Payer |
$27,319.56
|
|
|
TIBIAL SLEEVE OSS PROX 7CM
|
Facility
|
IP
|
$31,044.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,035.84 |
| Max. Negotiated Rate |
$29,803.16 |
| Rate for Payer: Aetna Commercial |
$23,904.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,215.07
|
| Rate for Payer: Cash Price |
$15,522.48
|
| Rate for Payer: Cigna Commercial |
$25,767.32
|
| Rate for Payer: First Health Commercial |
$29,492.71
|
| Rate for Payer: Humana Commercial |
$26,388.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,456.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,911.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,313.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,319.56
|
| Rate for Payer: Ohio Health Group HMO |
$23,283.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,208.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,035.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,623.94
|
| Rate for Payer: PHCS Commercial |
$29,803.16
|
| Rate for Payer: United Healthcare All Payer |
$27,319.56
|
|
|
TIBIAL SLEEVE OSS PROX 9CM
|
Facility
|
OP
|
$37,584.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,885.96 |
| Max. Negotiated Rate |
$36,080.93 |
| Rate for Payer: Aetna Commercial |
$28,939.91
|
| Rate for Payer: Anthem Medicaid |
$12,925.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,315.75
|
| Rate for Payer: Cash Price |
$18,792.15
|
| Rate for Payer: Cigna Commercial |
$31,194.97
|
| Rate for Payer: First Health Commercial |
$35,705.08
|
| Rate for Payer: Humana Commercial |
$31,946.66
|
| Rate for Payer: Humana KY Medicaid |
$12,925.24
|
| Rate for Payer: Kentucky WC Medicaid |
$13,056.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,819.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,737.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,275.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,184.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,074.18
|
| Rate for Payer: Ohio Health Group HMO |
$28,188.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,516.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,885.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,651.13
|
| Rate for Payer: PHCS Commercial |
$36,080.93
|
| Rate for Payer: United Healthcare All Payer |
$33,074.18
|
|
|
TIBIAL SLEEVE OSS PROX 9CM
|
Facility
|
IP
|
$37,584.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,885.96 |
| Max. Negotiated Rate |
$36,080.93 |
| Rate for Payer: Aetna Commercial |
$28,939.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,315.75
|
| Rate for Payer: Cash Price |
$18,792.15
|
| Rate for Payer: Cigna Commercial |
$31,194.97
|
| Rate for Payer: First Health Commercial |
$35,705.08
|
| Rate for Payer: Humana Commercial |
$31,946.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,819.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,737.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,275.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,074.18
|
| Rate for Payer: Ohio Health Group HMO |
$28,188.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,516.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,885.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,651.13
|
| Rate for Payer: PHCS Commercial |
$36,080.93
|
| Rate for Payer: United Healthcare All Payer |
$33,074.18
|
|
|
TIBIAL SLEEVE PROX OSS RS 3CM
|
Facility
|
OP
|
$17,708.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.12 |
| Max. Negotiated Rate |
$17,000.29 |
| Rate for Payer: Aetna Commercial |
$13,635.65
|
| Rate for Payer: Anthem Medicaid |
$6,090.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,812.74
|
| Rate for Payer: Cash Price |
$8,854.32
|
| Rate for Payer: Cigna Commercial |
$14,698.17
|
| Rate for Payer: First Health Commercial |
$16,823.21
|
| Rate for Payer: Humana Commercial |
$15,052.34
|
| Rate for Payer: Humana KY Medicaid |
$6,090.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,151.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,521.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,068.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,312.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,212.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,583.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,281.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,541.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,489.68
|
| Rate for Payer: PHCS Commercial |
$17,000.29
|
| Rate for Payer: United Healthcare All Payer |
$15,583.60
|
|
|
TIBIAL SLEEVE PROX OSS RS 3CM
|
Facility
|
IP
|
$17,708.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.12 |
| Max. Negotiated Rate |
$17,000.29 |
| Rate for Payer: Aetna Commercial |
$13,635.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,812.74
|
| Rate for Payer: Cash Price |
$8,854.32
|
| Rate for Payer: Cigna Commercial |
$14,698.17
|
| Rate for Payer: First Health Commercial |
$16,823.21
|
| Rate for Payer: Humana Commercial |
$15,052.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,521.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,068.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,312.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,583.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,281.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,541.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,489.68
|
| Rate for Payer: PHCS Commercial |
$17,000.29
|
| Rate for Payer: United Healthcare All Payer |
$15,583.60
|
|
