|
TRITANIUM HEMI CLUSTER SHELL 4
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
TRITANIUM HEMI CLUSTER SHELL 4
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
TRITANIUM HEMI CLUSTER SHELL 5
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
TRITANIUM HEMI CLUSTER SHELL 5
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
TRITANIUM HEMI CLUSTER SHELL 6
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
TRITANIUM HEMI CLUSTER SHELL 6
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
TRITANIUM TIB CONE AUGMENT
|
Facility
|
IP
|
$24,524.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,357.21 |
| Max. Negotiated Rate |
$23,543.08 |
| Rate for Payer: Aetna Commercial |
$18,883.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,128.75
|
| Rate for Payer: Cash Price |
$12,262.02
|
| Rate for Payer: Cigna Commercial |
$20,354.95
|
| Rate for Payer: First Health Commercial |
$23,297.84
|
| Rate for Payer: Humana Commercial |
$20,845.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,109.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,098.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,357.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,581.16
|
| Rate for Payer: Ohio Health Group HMO |
$18,393.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,619.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,335.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,921.59
|
| Rate for Payer: PHCS Commercial |
$23,543.08
|
| Rate for Payer: United Healthcare All Payer |
$21,581.16
|
|
|
TRITANIUM TIB CONE AUGMENT
|
Facility
|
OP
|
$24,524.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,357.21 |
| Max. Negotiated Rate |
$23,543.08 |
| Rate for Payer: Aetna Commercial |
$18,883.51
|
| Rate for Payer: Anthem Medicaid |
$8,433.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,128.75
|
| Rate for Payer: Cash Price |
$12,262.02
|
| Rate for Payer: Cigna Commercial |
$20,354.95
|
| Rate for Payer: First Health Commercial |
$23,297.84
|
| Rate for Payer: Humana Commercial |
$20,845.43
|
| Rate for Payer: Humana KY Medicaid |
$8,433.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,519.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,109.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,098.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,357.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,603.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,581.16
|
| Rate for Payer: Ohio Health Group HMO |
$18,393.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,619.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,335.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,921.59
|
| Rate for Payer: PHCS Commercial |
$23,543.08
|
| Rate for Payer: United Healthcare All Payer |
$21,581.16
|
|
|
TRI TS BASEPLATE SIZE 1
|
Facility
|
IP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 1
|
Facility
|
OP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem Medicaid |
$3,109.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Humana KY Medicaid |
$3,109.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 2
|
Facility
|
IP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 2
|
Facility
|
OP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem Medicaid |
$3,109.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Humana KY Medicaid |
$3,109.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 3
|
Facility
|
IP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 3
|
Facility
|
OP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem Medicaid |
$3,109.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Humana KY Medicaid |
$3,109.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 4
|
Facility
|
IP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 4
|
Facility
|
OP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem Medicaid |
$3,109.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Humana KY Medicaid |
$3,109.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 5
|
Facility
|
IP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 5
|
Facility
|
OP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem Medicaid |
$3,109.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Humana KY Medicaid |
$3,109.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 6
|
Facility
|
IP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 6
|
Facility
|
OP
|
$9,041.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.51 |
| Max. Negotiated Rate |
$8,680.03 |
| Rate for Payer: Aetna Commercial |
$6,962.11
|
| Rate for Payer: Anthem Medicaid |
$3,109.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.53
|
| Rate for Payer: Cash Price |
$4,520.85
|
| Rate for Payer: Cigna Commercial |
$7,504.61
|
| Rate for Payer: First Health Commercial |
$8,589.61
|
| Rate for Payer: Humana Commercial |
$7,685.44
|
| Rate for Payer: Humana KY Medicaid |
$3,109.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,233.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,866.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,238.77
|
| Rate for Payer: PHCS Commercial |
$8,680.03
|
| Rate for Payer: United Healthcare All Payer |
$7,956.70
|
|
|
TRI TS BASEPLATE SIZE 7
|
Facility
|
IP
|
$9,102.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.82 |
| Max. Negotiated Rate |
$8,738.62 |
| Rate for Payer: Aetna Commercial |
$7,009.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,100.13
|
| Rate for Payer: Cash Price |
$4,551.36
|
| Rate for Payer: Cigna Commercial |
$7,555.27
|
| Rate for Payer: First Health Commercial |
$8,647.59
|
| Rate for Payer: Humana Commercial |
$7,737.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,464.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,717.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,010.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,282.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,919.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,280.88
|
| Rate for Payer: PHCS Commercial |
$8,738.62
|
| Rate for Payer: United Healthcare All Payer |
$8,010.40
|
|
|
TRI TS BASEPLATE SIZE 7
|
Facility
|
OP
|
$9,102.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.82 |
| Max. Negotiated Rate |
$8,738.62 |
| Rate for Payer: Aetna Commercial |
$7,009.10
|
| Rate for Payer: Anthem Medicaid |
$3,130.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,100.13
|
| Rate for Payer: Cash Price |
$4,551.36
|
| Rate for Payer: Cigna Commercial |
$7,555.27
|
| Rate for Payer: First Health Commercial |
$8,647.59
|
| Rate for Payer: Humana Commercial |
$7,737.32
|
| Rate for Payer: Humana KY Medicaid |
$3,130.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,162.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,464.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,717.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,193.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,010.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,282.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,919.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,280.88
|
| Rate for Payer: PHCS Commercial |
$8,738.62
|
| Rate for Payer: United Healthcare All Payer |
$8,010.40
|
|
|
TRI TS BASEPLATE SIZE 8
|
Facility
|
IP
|
$10,950.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,285.03 |
| Max. Negotiated Rate |
$10,512.10 |
| Rate for Payer: Aetna Commercial |
$8,431.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.08
|
| Rate for Payer: Cash Price |
$5,475.05
|
| Rate for Payer: Cigna Commercial |
$9,088.58
|
| Rate for Payer: First Health Commercial |
$10,402.59
|
| Rate for Payer: Humana Commercial |
$9,307.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,760.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,526.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,555.57
|
| Rate for Payer: PHCS Commercial |
$10,512.10
|
| Rate for Payer: United Healthcare All Payer |
$9,636.09
|
|
|
TRI TS BASEPLATE SIZE 8
|
Facility
|
OP
|
$10,950.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,285.03 |
| Max. Negotiated Rate |
$10,512.10 |
| Rate for Payer: Aetna Commercial |
$8,431.58
|
| Rate for Payer: Anthem Medicaid |
$3,765.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.08
|
| Rate for Payer: Cash Price |
$5,475.05
|
| Rate for Payer: Cigna Commercial |
$9,088.58
|
| Rate for Payer: First Health Commercial |
$10,402.59
|
| Rate for Payer: Humana Commercial |
$9,307.58
|
| Rate for Payer: Humana KY Medicaid |
$3,765.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,760.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,526.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,555.57
|
| Rate for Payer: PHCS Commercial |
$10,512.10
|
| Rate for Payer: United Healthcare All Payer |
$9,636.09
|
|
|
TRI TS FEMUR SZ 1 LEFT
|
Facility
|
IP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
