|
TIBIAL BASE PLAT OSS RS SHT 47
|
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 PLAT OSS RS SHT 51
|
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 PLAT OSS RS SHT 51
|
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 PLAT OSS RS SHT 55
|
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 PLAT OSS RS SHT 55
|
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 PLAT OSS RS SHT 59
|
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 PLAT OSS RS SHT 59
|
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 PLAT OSS RS SHT 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 PLAT OSS RS SHT 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 PLAT OSS RS SHT 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 PLAT OSS RS SHT 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 PLAT OSS RS SHT 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 PLAT OSS RS SHT 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 POROUS HA SZ 2 LT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 2 LT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 2 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 2 RT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 3 LT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 3 LT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 3 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 3 RT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 4 LT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 4 LT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 4 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TIBIAL BASE POROUS HA SZ 4 RT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
