|
G2 POST ART INSERT SZ 7-8 15MM
|
Facility
|
IP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
G2 PS HI FLEX ISRT SZ5-6*21
|
Facility
|
OP
|
$4,925.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.33 |
| Max. Negotiated Rate |
$4,728.60 |
| Rate for Payer: Aetna Commercial |
$3,792.73
|
| Rate for Payer: Anthem Medicaid |
$1,693.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.98
|
| Rate for Payer: Cash Price |
$2,462.81
|
| Rate for Payer: Cigna Commercial |
$4,088.26
|
| Rate for Payer: First Health Commercial |
$4,679.34
|
| Rate for Payer: Humana Commercial |
$4,186.78
|
| Rate for Payer: Humana KY Medicaid |
$1,693.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,711.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.94
|
| Rate for Payer: PHCS Commercial |
$4,728.60
|
| Rate for Payer: United Healthcare All Payer |
$4,334.55
|
|
|
G2 PS HI FLEX ISRT SZ5-6*21
|
Facility
|
IP
|
$4,925.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.33 |
| Max. Negotiated Rate |
$4,728.60 |
| Rate for Payer: Aetna Commercial |
$3,792.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.98
|
| Rate for Payer: Cash Price |
$2,462.81
|
| Rate for Payer: Cigna Commercial |
$4,088.26
|
| Rate for Payer: First Health Commercial |
$4,679.34
|
| Rate for Payer: Humana Commercial |
$4,186.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.94
|
| Rate for Payer: PHCS Commercial |
$4,728.60
|
| Rate for Payer: United Healthcare All Payer |
$4,334.55
|
|
|
G2 TIBIAL FIN FIX 1-2
|
Facility
|
OP
|
$2,139.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.13 |
| Max. Negotiated Rate |
$2,053.85 |
| Rate for Payer: Aetna Commercial |
$1,647.36
|
| Rate for Payer: Anthem Medicaid |
$735.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,668.76
|
| Rate for Payer: Cash Price |
$1,069.71
|
| Rate for Payer: Cigna Commercial |
$1,775.73
|
| Rate for Payer: First Health Commercial |
$2,032.46
|
| Rate for Payer: Humana Commercial |
$1,818.52
|
| Rate for Payer: Humana KY Medicaid |
$735.75
|
| Rate for Payer: Kentucky WC Medicaid |
$743.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,754.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,578.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$750.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,882.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,604.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.22
|
| Rate for Payer: PHCS Commercial |
$2,053.85
|
| Rate for Payer: United Healthcare All Payer |
$1,882.70
|
|
|
G2 TIBIAL FIN FIX 1-2
|
Facility
|
IP
|
$2,139.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.13 |
| Max. Negotiated Rate |
$2,053.85 |
| Rate for Payer: Aetna Commercial |
$1,647.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,668.76
|
| Rate for Payer: Cash Price |
$1,069.71
|
| Rate for Payer: Cigna Commercial |
$1,775.73
|
| Rate for Payer: First Health Commercial |
$2,032.46
|
| Rate for Payer: Humana Commercial |
$1,818.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,754.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,578.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,882.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,604.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.22
|
| Rate for Payer: PHCS Commercial |
$2,053.85
|
| Rate for Payer: United Healthcare All Payer |
$1,882.70
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421141
|
Facility
|
IP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421141
|
Facility
|
OP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem Medicaid |
$3,733.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Humana KY Medicaid |
$3,733.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,771.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,808.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421145
|
Facility
|
IP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
G2 TIBIAL WDGE SZ 1-2 71421145
|
Facility
|
OP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem Medicaid |
$3,733.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Humana KY Medicaid |
$3,733.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,771.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,808.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423017
|
Facility
|
IP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423017
|
Facility
|
OP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem Medicaid |
$2,376.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Humana KY Medicaid |
$2,376.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,400.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423018
|
Facility
|
OP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem Medicaid |
$2,376.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Humana KY Medicaid |
$2,376.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,400.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423018
|
Facility
|
IP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423021
|
Facility
|
OP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem Medicaid |
$2,376.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Humana KY Medicaid |
$2,376.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,400.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423021
|
Facility
|
IP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423025
|
Facility
|
OP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem Medicaid |
$2,376.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Humana KY Medicaid |
$2,376.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,400.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423025
|
Facility
|
IP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423029
|
Facility
|
IP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423029
|
Facility
|
OP
|
$6,910.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.41 |
| Max. Negotiated Rate |
$6,634.38 |
| Rate for Payer: Aetna Commercial |
$5,321.32
|
| Rate for Payer: Anthem Medicaid |
$2,376.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,390.43
|
| Rate for Payer: Cash Price |
$3,455.41
|
| Rate for Payer: Cigna Commercial |
$5,735.97
|
| Rate for Payer: First Health Commercial |
$6,565.27
|
| Rate for Payer: Humana Commercial |
$5,874.19
|
| Rate for Payer: Humana KY Medicaid |
$2,376.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,400.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,666.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,100.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,073.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,424.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,081.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,183.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,382.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,142.35
|
| Rate for Payer: PHCS Commercial |
$6,634.38
|
| Rate for Payer: United Healthcare All Payer |
$6,081.51
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423033
|
Facility
|
OP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem Medicaid |
$2,616.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Humana KY Medicaid |
$2,616.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423033
|
Facility
|
IP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423037
|
Facility
|
OP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem Medicaid |
$2,616.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Humana KY Medicaid |
$2,616.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423037
|
Facility
|
IP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423049
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423049
|
Facility
|
IP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
