|
TIBIAL BLCKAUG RS20*55/59MR/LL
|
Facility
|
OP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBIAL BODY PROX OSS ELLPT 9CM
|
Facility
|
IP
|
$77,275.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,182.54 |
| Max. Negotiated Rate |
$74,184.12 |
| Rate for Payer: Aetna Commercial |
$59,501.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,274.59
|
| Rate for Payer: Cash Price |
$38,637.56
|
| Rate for Payer: Cigna Commercial |
$64,138.35
|
| Rate for Payer: First Health Commercial |
$73,411.36
|
| Rate for Payer: Humana Commercial |
$65,683.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,365.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,029.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,182.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,002.11
|
| Rate for Payer: Ohio Health Group HMO |
$57,956.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,820.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,229.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,319.83
|
| Rate for Payer: PHCS Commercial |
$74,184.12
|
| Rate for Payer: United Healthcare All Payer |
$68,002.11
|
|
|
TIBIAL BODY PROX OSS ELLPT 9CM
|
Facility
|
OP
|
$77,275.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,182.54 |
| Max. Negotiated Rate |
$74,184.12 |
| Rate for Payer: Aetna Commercial |
$59,501.84
|
| Rate for Payer: Anthem Medicaid |
$26,574.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,274.59
|
| Rate for Payer: Cash Price |
$38,637.56
|
| Rate for Payer: Cigna Commercial |
$64,138.35
|
| Rate for Payer: First Health Commercial |
$73,411.36
|
| Rate for Payer: Humana Commercial |
$65,683.85
|
| Rate for Payer: Humana KY Medicaid |
$26,574.91
|
| Rate for Payer: Kentucky WC Medicaid |
$26,845.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,365.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,029.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,182.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,108.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,002.11
|
| Rate for Payer: Ohio Health Group HMO |
$57,956.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,820.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,229.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,319.83
|
| Rate for Payer: PHCS Commercial |
$74,184.12
|
| Rate for Payer: United Healthcare All Payer |
$68,002.11
|
|
|
TIBIAL BUSHING OSS POLY
|
Facility
|
IP
|
$3,654.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.24 |
| Max. Negotiated Rate |
$3,507.96 |
| Rate for Payer: Aetna Commercial |
$2,813.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,850.21
|
| Rate for Payer: Cash Price |
$1,827.06
|
| Rate for Payer: Cigna Commercial |
$3,032.92
|
| Rate for Payer: First Health Commercial |
$3,471.41
|
| Rate for Payer: Humana Commercial |
$3,106.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,996.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,696.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,215.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,740.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,923.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,179.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,521.34
|
| Rate for Payer: PHCS Commercial |
$3,507.96
|
| Rate for Payer: United Healthcare All Payer |
$3,215.63
|
|
|
TIBIAL BUSHING OSS POLY
|
Facility
|
OP
|
$3,654.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.24 |
| Max. Negotiated Rate |
$3,507.96 |
| Rate for Payer: Aetna Commercial |
$2,813.67
|
| Rate for Payer: Anthem Medicaid |
$1,256.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,850.21
|
| Rate for Payer: Cash Price |
$1,827.06
|
| Rate for Payer: Cigna Commercial |
$3,032.92
|
| Rate for Payer: First Health Commercial |
$3,471.41
|
| Rate for Payer: Humana Commercial |
$3,106.00
|
| Rate for Payer: Humana KY Medicaid |
$1,256.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,269.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,996.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,696.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,215.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,740.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,923.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,179.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,521.34
|
| Rate for Payer: PHCS Commercial |
$3,507.96
|
| Rate for Payer: United Healthcare All Payer |
$3,215.63
|
|
|
TIBIAL CEM MBT REV SZ 2
|
Facility
|
OP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem Medicaid |
$11,456.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Humana KY Medicaid |
$11,456.88
|
| Rate for Payer: Kentucky WC Medicaid |
$11,573.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 2
|
Facility
|
IP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 2.5
|
Facility
|
IP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 2.5
|
Facility
|
OP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem Medicaid |
$11,456.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Humana KY Medicaid |
$11,456.88
|
| Rate for Payer: Kentucky WC Medicaid |
$11,573.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 3
|
Facility
|
IP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 3
|
Facility
|
OP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem Medicaid |
$11,456.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Humana KY Medicaid |
$11,456.88
|
| Rate for Payer: Kentucky WC Medicaid |
$11,573.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 4
|
Facility
|
IP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 4
|
Facility
|
OP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem Medicaid |
$11,456.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Humana KY Medicaid |
$11,456.88
|
| Rate for Payer: Kentucky WC Medicaid |
$11,573.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 5
|
Facility
|
IP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 5
|
Facility
|
OP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem Medicaid |
$11,456.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Humana KY Medicaid |
$11,456.88
|
| Rate for Payer: Kentucky WC Medicaid |
$11,573.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
TIBIAL CEM MBT REV SZ 6
|
Facility
|
IP
|
$38,311.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,493.38 |
| Max. Negotiated Rate |
$36,778.80 |
| Rate for Payer: Aetna Commercial |
$29,499.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,882.78
|
| Rate for Payer: Cash Price |
$19,155.62
|
| Rate for Payer: Cigna Commercial |
$31,798.34
|
| Rate for Payer: First Health Commercial |
$36,395.69
|
| Rate for Payer: Humana Commercial |
$32,564.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,415.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,273.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,493.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,713.90
|
| Rate for Payer: Ohio Health Group HMO |
$28,733.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,649.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,330.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,434.76
|
| Rate for Payer: PHCS Commercial |
$36,778.80
|
| Rate for Payer: United Healthcare All Payer |
$33,713.90
|
|
|
TIBIAL CEM MBT REV SZ 6
|
Facility
|
OP
|
$38,311.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,493.38 |
| Max. Negotiated Rate |
$36,778.80 |
| Rate for Payer: Aetna Commercial |
$29,499.66
|
| Rate for Payer: Anthem Medicaid |
$13,175.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,882.78
|
| Rate for Payer: Cash Price |
$19,155.62
|
| Rate for Payer: Cigna Commercial |
$31,798.34
|
| Rate for Payer: First Health Commercial |
$36,395.69
|
| Rate for Payer: Humana Commercial |
$32,564.56
|
| Rate for Payer: Humana KY Medicaid |
$13,175.24
|
| Rate for Payer: Kentucky WC Medicaid |
$13,309.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,415.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,273.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,493.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,439.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,713.90
|
| Rate for Payer: Ohio Health Group HMO |
$28,733.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,649.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,330.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,434.76
|
| Rate for Payer: PHCS Commercial |
$36,778.80
|
| Rate for Payer: United Healthcare All Payer |
$33,713.90
|
|
|
TIBIAL CMP OSSAVL MOD PLT TPE
|
Facility
|
IP
|
$27,306.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,191.95 |
| Max. Negotiated Rate |
$26,214.24 |
| Rate for Payer: Aetna Commercial |
$21,026.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,299.07
|
| Rate for Payer: Cash Price |
$13,653.25
|
| Rate for Payer: Cigna Commercial |
$22,664.40
|
| Rate for Payer: First Health Commercial |
$25,941.17
|
| Rate for Payer: Humana Commercial |
$23,210.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,391.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,152.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,191.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,029.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,479.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,845.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,756.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,841.49
|
| Rate for Payer: PHCS Commercial |
$26,214.24
|
| Rate for Payer: United Healthcare All Payer |
$24,029.72
|
|
|
TIBIAL CMP OSSAVL MOD PLT TPE
|
Facility
|
OP
|
$27,306.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,191.95 |
| Max. Negotiated Rate |
$26,214.24 |
| Rate for Payer: Aetna Commercial |
$21,026.01
|
| Rate for Payer: Anthem Medicaid |
$9,390.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,299.07
|
| Rate for Payer: Cash Price |
$13,653.25
|
| Rate for Payer: Cigna Commercial |
$22,664.40
|
| Rate for Payer: First Health Commercial |
$25,941.17
|
| Rate for Payer: Humana Commercial |
$23,210.53
|
| Rate for Payer: Humana KY Medicaid |
$9,390.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9,486.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,391.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,152.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,191.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,579.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,029.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,479.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,845.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,756.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,841.49
|
| Rate for Payer: PHCS Commercial |
$26,214.24
|
| Rate for Payer: United Healthcare All Payer |
$24,029.72
|
|
|
TIBIAL CMP OSSAVL NONMOD 67 LG
|
Facility
|
IP
|
$26,901.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,070.45 |
| Max. Negotiated Rate |
$25,825.44 |
| Rate for Payer: Aetna Commercial |
$20,714.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,983.17
|
| Rate for Payer: Cash Price |
$13,450.75
|
| Rate for Payer: Cigna Commercial |
$22,328.24
|
| Rate for Payer: First Health Commercial |
$25,556.42
|
| Rate for Payer: Humana Commercial |
$22,866.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,059.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,853.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,070.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,673.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,176.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,521.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,404.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,562.03
|
| Rate for Payer: PHCS Commercial |
$25,825.44
|
| Rate for Payer: United Healthcare All Payer |
$23,673.32
|
|
|
TIBIAL CMP OSSAVL NONMOD 67 LG
|
Facility
|
OP
|
$26,901.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,070.45 |
| Max. Negotiated Rate |
$25,825.44 |
| Rate for Payer: Aetna Commercial |
$20,714.15
|
| Rate for Payer: Anthem Medicaid |
$9,251.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,983.17
|
| Rate for Payer: Cash Price |
$13,450.75
|
| Rate for Payer: Cigna Commercial |
$22,328.24
|
| Rate for Payer: First Health Commercial |
$25,556.42
|
| Rate for Payer: Humana Commercial |
$22,866.28
|
| Rate for Payer: Humana KY Medicaid |
$9,251.43
|
| Rate for Payer: Kentucky WC Medicaid |
$9,345.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,059.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,853.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,070.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,437.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,673.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,176.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,521.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,404.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,562.03
|
| Rate for Payer: PHCS Commercial |
$25,825.44
|
| Rate for Payer: United Healthcare All Payer |
$23,673.32
|
|
|
TIBIAL CMP OSSAVL TPE 63 SHRT
|
Facility
|
IP
|
$26,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,827.45 |
| Max. Negotiated Rate |
$25,047.84 |
| Rate for Payer: Aetna Commercial |
$20,090.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,351.37
|
| Rate for Payer: Cash Price |
$13,045.75
|
| Rate for Payer: Cigna Commercial |
$21,655.94
|
| Rate for Payer: First Health Commercial |
$24,786.92
|
| Rate for Payer: Humana Commercial |
$22,177.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,395.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,827.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,960.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,568.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,003.13
|
| Rate for Payer: PHCS Commercial |
$25,047.84
|
| Rate for Payer: United Healthcare All Payer |
$22,960.52
|
|
|
TIBIAL CMP OSSAVL TPE 63 SHRT
|
Facility
|
OP
|
$26,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,827.45 |
| Max. Negotiated Rate |
$25,047.84 |
| Rate for Payer: Aetna Commercial |
$20,090.46
|
| Rate for Payer: Anthem Medicaid |
$8,972.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,351.37
|
| Rate for Payer: Cash Price |
$13,045.75
|
| Rate for Payer: Cigna Commercial |
$21,655.94
|
| Rate for Payer: First Health Commercial |
$24,786.92
|
| Rate for Payer: Humana Commercial |
$22,177.78
|
| Rate for Payer: Humana KY Medicaid |
$8,972.87
|
| Rate for Payer: Kentucky WC Medicaid |
$9,064.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,395.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,827.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,152.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,960.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,568.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,003.13
|
| Rate for Payer: PHCS Commercial |
$25,047.84
|
| Rate for Payer: United Healthcare All Payer |
$22,960.52
|
|
|
TIBIAL CMP OSSAVL TPE 67 SHRT
|
Facility
|
IP
|
$26,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,827.45 |
| Max. Negotiated Rate |
$25,047.84 |
| Rate for Payer: Aetna Commercial |
$20,090.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,351.37
|
| Rate for Payer: Cash Price |
$13,045.75
|
| Rate for Payer: Cigna Commercial |
$21,655.94
|
| Rate for Payer: First Health Commercial |
$24,786.92
|
| Rate for Payer: Humana Commercial |
$22,177.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,395.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,827.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,960.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,568.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,003.13
|
| Rate for Payer: PHCS Commercial |
$25,047.84
|
| Rate for Payer: United Healthcare All Payer |
$22,960.52
|
|
|
TIBIAL CMP OSSAVL TPE 67 SHRT
|
Facility
|
OP
|
$26,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,827.45 |
| Max. Negotiated Rate |
$25,047.84 |
| Rate for Payer: Aetna Commercial |
$20,090.46
|
| Rate for Payer: Anthem Medicaid |
$8,972.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,351.37
|
| Rate for Payer: Cash Price |
$13,045.75
|
| Rate for Payer: Cigna Commercial |
$21,655.94
|
| Rate for Payer: First Health Commercial |
$24,786.92
|
| Rate for Payer: Humana Commercial |
$22,177.78
|
| Rate for Payer: Humana KY Medicaid |
$8,972.87
|
| Rate for Payer: Kentucky WC Medicaid |
$9,064.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,395.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,827.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,152.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,960.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,568.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,003.13
|
| Rate for Payer: PHCS Commercial |
$25,047.84
|
| Rate for Payer: United Healthcare All Payer |
$22,960.52
|
|
