|
TIBIAL WEDGE LUG 10MM
|
Facility
|
IP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
|
TIBIAL WEDGE LUG 15MM
|
Facility
|
OP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem Medicaid |
$1,089.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Humana KY Medicaid |
$1,089.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
|
TIBIAL WEDGE LUG 15MM
|
Facility
|
IP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
|
TIBIA PSN CMT 5 DEG SZ C L
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ C L
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ C R
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ C R
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ D L
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ D L
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ D R
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ D R
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ E L
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ E L
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ E R
|
Facility
|
OP
|
$8,192.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.07 |
| Max. Negotiated Rate |
$7,865.16 |
| Rate for Payer: Aetna Commercial |
$6,308.52
|
| Rate for Payer: Anthem Medicaid |
$2,817.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,390.45
|
| Rate for Payer: Cash Price |
$4,096.44
|
| Rate for Payer: Cigna Commercial |
$6,800.09
|
| Rate for Payer: First Health Commercial |
$7,783.24
|
| Rate for Payer: Humana Commercial |
$6,963.95
|
| Rate for Payer: Humana KY Medicaid |
$2,817.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,846.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,718.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,046.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,874.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,209.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,144.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.79
|
| Rate for Payer: PHCS Commercial |
$7,865.16
|
| Rate for Payer: United Healthcare All Payer |
$7,209.73
|
|
|
TIBIA PSN CMT 5 DEG SZ E R
|
Facility
|
IP
|
$8,192.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.07 |
| Max. Negotiated Rate |
$7,865.16 |
| Rate for Payer: Aetna Commercial |
$6,308.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,390.45
|
| Rate for Payer: Cash Price |
$4,096.44
|
| Rate for Payer: Cigna Commercial |
$6,800.09
|
| Rate for Payer: First Health Commercial |
$7,783.24
|
| Rate for Payer: Humana Commercial |
$6,963.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,718.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,046.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,209.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,144.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.79
|
| Rate for Payer: PHCS Commercial |
$7,865.16
|
| Rate for Payer: United Healthcare All Payer |
$7,209.73
|
|
|
TIBIA PSN CMT 5 DEG SZ F L
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ F L
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ F R
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ F R
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G L
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G L
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G R
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G R
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ J L
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
TIBIA PSN CMT 5 DEG SZ J L
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
