|
TIBIAL CMP OSSAVL TPE 71 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 71 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 COMP OSSAVL BEARNG 12MM
|
Facility
|
OP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem Medicaid |
$3,279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Humana KY Medicaid |
$3,279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,312.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,344.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 12MM
|
Facility
|
IP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 14MM
|
Facility
|
OP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem Medicaid |
$3,279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Humana KY Medicaid |
$3,279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,312.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,344.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 14MM
|
Facility
|
IP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 16MM
|
Facility
|
OP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem Medicaid |
$3,279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Humana KY Medicaid |
$3,279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,312.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,344.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL COMP OSSAVL BEARNG 16MM
|
Facility
|
IP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL COMP OSS AVL LOCK RING
|
Facility
|
OP
|
$4,497.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.25 |
| Max. Negotiated Rate |
$4,317.60 |
| Rate for Payer: Aetna Commercial |
$3,463.07
|
| Rate for Payer: Anthem Medicaid |
$1,546.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.05
|
| Rate for Payer: Cash Price |
$2,248.75
|
| Rate for Payer: Cigna Commercial |
$3,732.93
|
| Rate for Payer: First Health Commercial |
$4,272.62
|
| Rate for Payer: Humana Commercial |
$3,822.88
|
| Rate for Payer: Humana KY Medicaid |
$1,546.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,912.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.28
|
| Rate for Payer: PHCS Commercial |
$4,317.60
|
| Rate for Payer: United Healthcare All Payer |
$3,957.80
|
|
|
TIBIAL COMP OSS AVL LOCK RING
|
Facility
|
IP
|
$4,497.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.25 |
| Max. Negotiated Rate |
$4,317.60 |
| Rate for Payer: Aetna Commercial |
$3,463.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.05
|
| Rate for Payer: Cash Price |
$2,248.75
|
| Rate for Payer: Cigna Commercial |
$3,732.93
|
| Rate for Payer: First Health Commercial |
$4,272.62
|
| Rate for Payer: Humana Commercial |
$3,822.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,912.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.28
|
| Rate for Payer: PHCS Commercial |
$4,317.60
|
| Rate for Payer: United Healthcare All Payer |
$3,957.80
|
|
|
TIBIAL COMP OSS AVL MOD PLT 71
|
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 COMP OSS AVL MOD PLT 71
|
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 COMP OSS AVL MOD PLT 75
|
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 COMP OSS AVL MOD PLT 75
|
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 COMP OSSAVL PLY BUSH ST
|
Facility
|
IP
|
$4,124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.20 |
| Max. Negotiated Rate |
$3,959.04 |
| Rate for Payer: Aetna Commercial |
$3,175.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,216.72
|
| Rate for Payer: Cash Price |
$2,062.00
|
| Rate for Payer: Cigna Commercial |
$3,422.92
|
| Rate for Payer: First Health Commercial |
$3,917.80
|
| Rate for Payer: Humana Commercial |
$3,505.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,381.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,043.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,629.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,299.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.56
|
| Rate for Payer: PHCS Commercial |
$3,959.04
|
| Rate for Payer: United Healthcare All Payer |
$3,629.12
|
|
|
TIBIAL COMP OSSAVL PLY BUSH ST
|
Facility
|
OP
|
$4,124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.20 |
| Max. Negotiated Rate |
$3,959.04 |
| Rate for Payer: Aetna Commercial |
$3,175.48
|
| Rate for Payer: Anthem Medicaid |
$1,418.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,216.72
|
| Rate for Payer: Cash Price |
$2,062.00
|
| Rate for Payer: Cigna Commercial |
$3,422.92
|
| Rate for Payer: First Health Commercial |
$3,917.80
|
| Rate for Payer: Humana Commercial |
$3,505.40
|
| Rate for Payer: Humana KY Medicaid |
$1,418.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,432.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,381.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,043.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,446.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,629.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,299.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,845.56
|
| Rate for Payer: PHCS Commercial |
$3,959.04
|
| Rate for Payer: United Healthcare All Payer |
$3,629.12
|
|
|
TIBIAL COMP OSS AVL TAP 63 LNG
|
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 COMP OSS AVL TAP 63 LNG
|
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 COMP OSS AVL TAPE 79
|
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 COMP OSS AVL TAPE 79
|
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 COMP OSS AVL TAPE 83
|
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 COMP OSS AVL TAPE 83
|
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 COMP OSS AVL YOKE 12MM
|
Facility
|
IP
|
$8,615.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.55 |
| Max. Negotiated Rate |
$8,270.55 |
| Rate for Payer: Aetna Commercial |
$6,633.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.82
|
| Rate for Payer: Cash Price |
$4,307.58
|
| Rate for Payer: Cigna Commercial |
$7,150.58
|
| Rate for Payer: First Health Commercial |
$8,184.40
|
| Rate for Payer: Humana Commercial |
$7,322.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,357.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.46
|
| Rate for Payer: PHCS Commercial |
$8,270.55
|
| Rate for Payer: United Healthcare All Payer |
$7,581.34
|
|
|
TIBIAL COMP OSS AVL YOKE 12MM
|
Facility
|
OP
|
$8,615.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.55 |
| Max. Negotiated Rate |
$8,270.55 |
| Rate for Payer: Aetna Commercial |
$6,633.67
|
| Rate for Payer: Anthem Medicaid |
$2,962.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.82
|
| Rate for Payer: Cash Price |
$4,307.58
|
| Rate for Payer: Cigna Commercial |
$7,150.58
|
| Rate for Payer: First Health Commercial |
$8,184.40
|
| Rate for Payer: Humana Commercial |
$7,322.89
|
| Rate for Payer: Humana KY Medicaid |
$2,962.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,357.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.46
|
| Rate for Payer: PHCS Commercial |
$8,270.55
|
| Rate for Payer: United Healthcare All Payer |
$7,581.34
|
|
|
TIBIAL COMP OSS AVL YOKE 14MM
|
Facility
|
OP
|
$8,615.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.55 |
| Max. Negotiated Rate |
$8,270.55 |
| Rate for Payer: Aetna Commercial |
$6,633.67
|
| Rate for Payer: Anthem Medicaid |
$2,962.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.82
|
| Rate for Payer: Cash Price |
$4,307.58
|
| Rate for Payer: Cigna Commercial |
$7,150.58
|
| Rate for Payer: First Health Commercial |
$8,184.40
|
| Rate for Payer: Humana Commercial |
$7,322.89
|
| Rate for Payer: Humana KY Medicaid |
$2,962.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,357.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.46
|
| Rate for Payer: PHCS Commercial |
$8,270.55
|
| Rate for Payer: United Healthcare All Payer |
$7,581.34
|
|
