|
TRITANIUM HEMI CLUSTER SHELL 6
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
TRITANIUM HEMI CLUSTER SHELL 6
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
TRI TS BASEPLATE SIZE 1
|
Facility
|
OP
|
$10,709.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.24 |
| Max. Negotiated Rate |
$10,281.12 |
| Rate for Payer: Aetna Commercial |
$8,246.32
|
| Rate for Payer: Anthem Medicaid |
$3,683.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,353.41
|
| Rate for Payer: Cash Price |
$5,354.75
|
| Rate for Payer: Cigna Commercial |
$8,888.88
|
| Rate for Payer: First Health Commercial |
$10,174.02
|
| Rate for Payer: Humana Commercial |
$9,103.08
|
| Rate for Payer: Humana KY Medicaid |
$3,683.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,720.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,781.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,903.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,212.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,756.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,424.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,032.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,319.94
|
| Rate for Payer: PHCS Commercial |
$10,281.12
|
| Rate for Payer: United Healthcare All Payer |
$9,424.36
|
|
|
TRI TS BASEPLATE SIZE 1
|
Facility
|
IP
|
$10,709.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.24 |
| Max. Negotiated Rate |
$10,281.12 |
| Rate for Payer: Aetna Commercial |
$8,246.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,353.41
|
| Rate for Payer: Cash Price |
$5,354.75
|
| Rate for Payer: Cigna Commercial |
$8,888.88
|
| Rate for Payer: First Health Commercial |
$10,174.02
|
| Rate for Payer: Humana Commercial |
$9,103.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,781.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,903.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,212.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,424.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,032.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,319.94
|
| Rate for Payer: PHCS Commercial |
$10,281.12
|
| Rate for Payer: United Healthcare All Payer |
$9,424.36
|
|
|
TRI TS BASEPLATE SIZE 2
|
Facility
|
IP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 2
|
Facility
|
OP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem Medicaid |
$3,040.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Humana KY Medicaid |
$3,040.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 3
|
Facility
|
OP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem Medicaid |
$3,040.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Humana KY Medicaid |
$3,040.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 3
|
Facility
|
IP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 4
|
Facility
|
OP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem Medicaid |
$3,040.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Humana KY Medicaid |
$3,040.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 4
|
Facility
|
IP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 5
|
Facility
|
IP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 5
|
Facility
|
OP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem Medicaid |
$3,040.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Humana KY Medicaid |
$3,040.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 6
|
Facility
|
OP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem Medicaid |
$3,040.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Humana KY Medicaid |
$3,040.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 6
|
Facility
|
IP
|
$8,841.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.42 |
| Max. Negotiated Rate |
$8,488.03 |
| Rate for Payer: Aetna Commercial |
$6,808.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,896.53
|
| Rate for Payer: Cash Price |
$4,420.85
|
| Rate for Payer: Cigna Commercial |
$7,338.61
|
| Rate for Payer: First Health Commercial |
$8,399.62
|
| Rate for Payer: Humana Commercial |
$7,515.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,250.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,525.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,780.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,631.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,740.93
|
| Rate for Payer: PHCS Commercial |
$8,488.03
|
| Rate for Payer: United Healthcare All Payer |
$7,780.70
|
|
|
TRI TS BASEPLATE SIZE 7
|
Facility
|
IP
|
$8,902.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.35 |
| Max. Negotiated Rate |
$8,546.62 |
| Rate for Payer: Aetna Commercial |
$6,855.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,944.13
|
| Rate for Payer: Cash Price |
$4,451.36
|
| Rate for Payer: Cigna Commercial |
$7,389.27
|
| Rate for Payer: First Health Commercial |
$8,457.59
|
| Rate for Payer: Humana Commercial |
$7,567.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,300.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,570.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,834.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,677.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.85
|
| Rate for Payer: PHCS Commercial |
$8,546.62
|
| Rate for Payer: United Healthcare All Payer |
$7,834.40
|
|
|
TRI TS BASEPLATE SIZE 7
|
Facility
|
OP
|
$8,902.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.35 |
| Max. Negotiated Rate |
$8,546.62 |
| Rate for Payer: Aetna Commercial |
$6,855.10
|
| Rate for Payer: Anthem Medicaid |
$3,061.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,944.13
|
| Rate for Payer: Cash Price |
$4,451.36
|
| Rate for Payer: Cigna Commercial |
$7,389.27
|
| Rate for Payer: First Health Commercial |
$8,457.59
|
| Rate for Payer: Humana Commercial |
$7,567.32
|
| Rate for Payer: Humana KY Medicaid |
$3,061.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,092.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,300.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,570.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,123.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,834.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,677.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.85
|
| Rate for Payer: PHCS Commercial |
$8,546.62
|
| Rate for Payer: United Healthcare All Payer |
$7,834.40
|
|
|
TRI TS BASEPLATE SIZE 8
|
Facility
|
IP
|
$10,709.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.24 |
| Max. Negotiated Rate |
$10,281.12 |
| Rate for Payer: Aetna Commercial |
$8,246.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,353.41
|
| Rate for Payer: Cash Price |
$5,354.75
|
| Rate for Payer: Cigna Commercial |
$8,888.88
|
| Rate for Payer: First Health Commercial |
$10,174.02
|
| Rate for Payer: Humana Commercial |
$9,103.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,781.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,903.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,212.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,424.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,032.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,319.94
|
| Rate for Payer: PHCS Commercial |
$10,281.12
|
| Rate for Payer: United Healthcare All Payer |
$9,424.36
|
|
|
TRI TS BASEPLATE SIZE 8
|
Facility
|
OP
|
$10,709.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.24 |
| Max. Negotiated Rate |
$10,281.12 |
| Rate for Payer: Aetna Commercial |
$8,246.32
|
| Rate for Payer: Anthem Medicaid |
$3,683.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,353.41
|
| Rate for Payer: Cash Price |
$5,354.75
|
| Rate for Payer: Cigna Commercial |
$8,888.88
|
| Rate for Payer: First Health Commercial |
$10,174.02
|
| Rate for Payer: Humana Commercial |
$9,103.08
|
| Rate for Payer: Humana KY Medicaid |
$3,683.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,720.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,781.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,903.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,212.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,756.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,424.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,032.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,319.94
|
| Rate for Payer: PHCS Commercial |
$10,281.12
|
| Rate for Payer: United Healthcare All Payer |
$9,424.36
|
|
|
TRI TS FEMUR SZ 1 LEFT
|
Facility
|
IP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI TS FEMUR SZ 1 LEFT
|
Facility
|
OP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem Medicaid |
$2,805.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Humana KY Medicaid |
$2,805.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI TS FEMUR SZ 1 RIGHT
|
Facility
|
IP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI TS FEMUR SZ 1 RIGHT
|
Facility
|
OP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem Medicaid |
$2,805.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Humana KY Medicaid |
$2,805.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI TS FEMUR SZ 2 LEFT
|
Facility
|
OP
|
$32,874.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,273.66 |
| Max. Negotiated Rate |
$31,559.37 |
| Rate for Payer: Aetna Commercial |
$25,313.24
|
| Rate for Payer: Anthem Medicaid |
$11,305.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,641.99
|
| Rate for Payer: Cash Price |
$16,437.17
|
| Rate for Payer: Cigna Commercial |
$27,285.70
|
| Rate for Payer: First Health Commercial |
$31,230.62
|
| Rate for Payer: Humana Commercial |
$27,943.19
|
| Rate for Payer: Humana KY Medicaid |
$11,305.49
|
| Rate for Payer: Kentucky WC Medicaid |
$11,420.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,956.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,261.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,862.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,532.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,929.42
|
| Rate for Payer: Ohio Health Group HMO |
$24,655.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,574.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,273.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.05
|
| Rate for Payer: PHCS Commercial |
$31,559.37
|
| Rate for Payer: United Healthcare All Payer |
$28,929.42
|
|
|
TRI TS FEMUR SZ 2 LEFT
|
Facility
|
IP
|
$32,874.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,273.66 |
| Max. Negotiated Rate |
$31,559.37 |
| Rate for Payer: Aetna Commercial |
$25,313.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,641.99
|
| Rate for Payer: Cash Price |
$16,437.17
|
| Rate for Payer: Cigna Commercial |
$27,285.70
|
| Rate for Payer: First Health Commercial |
$31,230.62
|
| Rate for Payer: Humana Commercial |
$27,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,956.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,261.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,862.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,929.42
|
| Rate for Payer: Ohio Health Group HMO |
$24,655.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,574.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,273.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.05
|
| Rate for Payer: PHCS Commercial |
$31,559.37
|
| Rate for Payer: United Healthcare All Payer |
$28,929.42
|
|
|
TRI TS FEMUR SZ 2 RIGHT
|
Facility
|
OP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem Medicaid |
$10,758.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Humana KY Medicaid |
$10,758.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10,868.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,974.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
