|
TIBIAL BASE PLATE OSS SHORT 63
|
Facility
|
IP
|
$24,876.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,462.95 |
| Max. Negotiated Rate |
$23,881.44 |
| Rate for Payer: Aetna Commercial |
$19,154.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,403.67
|
| Rate for Payer: Cash Price |
$12,438.25
|
| Rate for Payer: Cigna Commercial |
$20,647.49
|
| Rate for Payer: First Health Commercial |
$23,632.67
|
| Rate for Payer: Humana Commercial |
$21,145.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,398.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,358.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,891.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,657.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,642.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,164.78
|
| Rate for Payer: PHCS Commercial |
$23,881.44
|
| Rate for Payer: United Healthcare All Payer |
$21,891.32
|
|
|
TIBIAL BASE PLATE OSS SHORT 63
|
Facility
|
OP
|
$24,876.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,462.95 |
| Max. Negotiated Rate |
$23,881.44 |
| Rate for Payer: Aetna Commercial |
$19,154.90
|
| Rate for Payer: Anthem Medicaid |
$8,555.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,403.67
|
| Rate for Payer: Cash Price |
$12,438.25
|
| Rate for Payer: Cigna Commercial |
$20,647.49
|
| Rate for Payer: First Health Commercial |
$23,632.67
|
| Rate for Payer: Humana Commercial |
$21,145.03
|
| Rate for Payer: Humana KY Medicaid |
$8,555.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,642.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,398.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,358.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,726.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,891.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,657.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,642.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,164.78
|
| Rate for Payer: PHCS Commercial |
$23,881.44
|
| Rate for Payer: United Healthcare All Payer |
$21,891.32
|
|
|
TIBIAL BASE PLATE OSS SHORT 67
|
Facility
|
OP
|
$24,876.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,462.95 |
| Max. Negotiated Rate |
$23,881.44 |
| Rate for Payer: Aetna Commercial |
$19,154.90
|
| Rate for Payer: Anthem Medicaid |
$8,555.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,403.67
|
| Rate for Payer: Cash Price |
$12,438.25
|
| Rate for Payer: Cigna Commercial |
$20,647.49
|
| Rate for Payer: First Health Commercial |
$23,632.67
|
| Rate for Payer: Humana Commercial |
$21,145.03
|
| Rate for Payer: Humana KY Medicaid |
$8,555.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,642.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,398.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,358.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,726.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,891.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,657.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,642.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,164.78
|
| Rate for Payer: PHCS Commercial |
$23,881.44
|
| Rate for Payer: United Healthcare All Payer |
$21,891.32
|
|
|
TIBIAL BASE PLATE OSS SHORT 67
|
Facility
|
IP
|
$24,876.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,462.95 |
| Max. Negotiated Rate |
$23,881.44 |
| Rate for Payer: Aetna Commercial |
$19,154.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,403.67
|
| Rate for Payer: Cash Price |
$12,438.25
|
| Rate for Payer: Cigna Commercial |
$20,647.49
|
| Rate for Payer: First Health Commercial |
$23,632.67
|
| Rate for Payer: Humana Commercial |
$21,145.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,398.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,358.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,891.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,657.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,642.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,164.78
|
| Rate for Payer: PHCS Commercial |
$23,881.44
|
| Rate for Payer: United Healthcare All Payer |
$21,891.32
|
|
|
TIBIAL BASE PLATE OSS SHORT 71
|
Facility
|
OP
|
$24,876.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,462.95 |
| Max. Negotiated Rate |
$23,881.44 |
| Rate for Payer: Aetna Commercial |
$19,154.90
|
| Rate for Payer: Anthem Medicaid |
$8,555.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,403.67
|
| Rate for Payer: Cash Price |
$12,438.25
|
| Rate for Payer: Cigna Commercial |
$20,647.49
|
| Rate for Payer: First Health Commercial |
$23,632.67
|
| Rate for Payer: Humana Commercial |
$21,145.03
|
| Rate for Payer: Humana KY Medicaid |
$8,555.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,642.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,398.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,358.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,726.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,891.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,657.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,642.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,164.78
|
| Rate for Payer: PHCS Commercial |
$23,881.44
|
| Rate for Payer: United Healthcare All Payer |
$21,891.32
|
|
|
TIBIAL BASE PLATE OSS SHORT 71
|
Facility
|
IP
|
$24,876.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,462.95 |
| Max. Negotiated Rate |
$23,881.44 |
| Rate for Payer: Aetna Commercial |
$19,154.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,403.67
|
| Rate for Payer: Cash Price |
$12,438.25
|
| Rate for Payer: Cigna Commercial |
$20,647.49
|
| Rate for Payer: First Health Commercial |
$23,632.67
|
| Rate for Payer: Humana Commercial |
$21,145.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,398.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,358.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,891.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,657.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,642.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,164.78
|
| Rate for Payer: PHCS Commercial |
$23,881.44
|
| Rate for Payer: United Healthcare All Payer |
$21,891.32
|
|
|
TIBIAL BASE PLATE OSS STD 75MM
|
Facility
|
IP
|
$24,000.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.09 |
| Max. Negotiated Rate |
$23,040.30 |
| Rate for Payer: Aetna Commercial |
$18,480.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,720.24
|
| Rate for Payer: Cash Price |
$12,000.16
|
| Rate for Payer: Cigna Commercial |
$19,920.26
|
| Rate for Payer: First Health Commercial |
$22,800.29
|
| Rate for Payer: Humana Commercial |
$20,400.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,680.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,712.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,200.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,120.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,000.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,200.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,880.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,560.21
|
| Rate for Payer: PHCS Commercial |
$23,040.30
|
| Rate for Payer: United Healthcare All Payer |
$21,120.27
|
|
|
TIBIAL BASE PLATE OSS STD 75MM
|
Facility
|
OP
|
$24,000.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.09 |
| Max. Negotiated Rate |
$23,040.30 |
| Rate for Payer: Aetna Commercial |
$18,480.24
|
| Rate for Payer: Anthem Medicaid |
$8,253.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,720.24
|
| Rate for Payer: Cash Price |
$12,000.16
|
| Rate for Payer: Cigna Commercial |
$19,920.26
|
| Rate for Payer: First Health Commercial |
$22,800.29
|
| Rate for Payer: Humana Commercial |
$20,400.26
|
| Rate for Payer: Humana KY Medicaid |
$8,253.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,337.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,680.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,712.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,200.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,419.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,120.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,000.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,200.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,880.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,560.21
|
| Rate for Payer: PHCS Commercial |
$23,040.30
|
| Rate for Payer: United Healthcare All Payer |
$21,120.27
|
|
|
TIBIAL BASEPLAT HYBRD PLY 63MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIBIAL BASEPLAT HYBRD PLY 63MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIBIAL BASE PLAT OSS RS LNG 47
|
Facility
|
OP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem Medicaid |
$8,810.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Humana KY Medicaid |
$8,810.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,987.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 47
|
Facility
|
IP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 51
|
Facility
|
OP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem Medicaid |
$8,810.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Humana KY Medicaid |
$8,810.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,987.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 51
|
Facility
|
IP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 55
|
Facility
|
IP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 55
|
Facility
|
OP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem Medicaid |
$8,810.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Humana KY Medicaid |
$8,810.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,987.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 59
|
Facility
|
OP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem Medicaid |
$8,810.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Humana KY Medicaid |
$8,810.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,987.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 59
|
Facility
|
IP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 63
|
Facility
|
OP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem Medicaid |
$8,810.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Humana KY Medicaid |
$8,810.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,987.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 63
|
Facility
|
IP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 67
|
Facility
|
OP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem Medicaid |
$8,810.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Humana KY Medicaid |
$8,810.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,987.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 67
|
Facility
|
IP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 71
|
Facility
|
OP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem Medicaid |
$8,810.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Humana KY Medicaid |
$8,810.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,987.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS LNG 71
|
Facility
|
IP
|
$25,619.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.70 |
| Max. Negotiated Rate |
$24,594.24 |
| Rate for Payer: Aetna Commercial |
$19,726.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,982.82
|
| Rate for Payer: Cash Price |
$12,809.50
|
| Rate for Payer: Cigna Commercial |
$21,263.77
|
| Rate for Payer: First Health Commercial |
$24,338.05
|
| Rate for Payer: Humana Commercial |
$21,776.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,007.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,906.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,544.72
|
| Rate for Payer: Ohio Health Group HMO |
$19,214.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,288.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,677.11
|
| Rate for Payer: PHCS Commercial |
$24,594.24
|
| Rate for Payer: United Healthcare All Payer |
$22,544.72
|
|
|
TIBIAL BASE PLAT OSS RS SHT 47
|
Facility
|
IP
|
$24,876.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,462.95 |
| Max. Negotiated Rate |
$23,881.44 |
| Rate for Payer: Aetna Commercial |
$19,154.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,403.67
|
| Rate for Payer: Cash Price |
$12,438.25
|
| Rate for Payer: Cigna Commercial |
$20,647.49
|
| Rate for Payer: First Health Commercial |
$23,632.67
|
| Rate for Payer: Humana Commercial |
$21,145.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,398.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,358.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,891.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,657.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,901.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,642.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,164.78
|
| Rate for Payer: PHCS Commercial |
$23,881.44
|
| Rate for Payer: United Healthcare All Payer |
$21,891.32
|
|
