|
G2 TIBIAL WDGE SZ 1-2 71423053
|
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
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423053
|
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 71423057
|
Facility
|
IP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423057
|
Facility
|
OP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem Medicaid |
$2,894.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Humana KY Medicaid |
$2,894.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423061
|
Facility
|
OP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem Medicaid |
$2,894.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Humana KY Medicaid |
$2,894.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 1-2 71423061
|
Facility
|
IP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423022
|
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 3-4 71423022
|
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 3-4 71423026
|
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 3-4 71423026
|
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 3-4 71423030
|
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 3-4 71423030
|
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 3-4 71423050
|
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 3-4 71423050
|
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
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423054
|
Facility
|
OP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem Medicaid |
$2,894.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Humana KY Medicaid |
$2,894.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423054
|
Facility
|
IP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423058
|
Facility
|
IP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423058
|
Facility
|
OP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem Medicaid |
$2,894.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Humana KY Medicaid |
$2,894.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423062
|
Facility
|
IP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 3-4 71423062
|
Facility
|
OP
|
$8,415.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.02 |
| Max. Negotiated Rate |
$8,078.90 |
| Rate for Payer: Aetna Commercial |
$6,479.95
|
| Rate for Payer: Anthem Medicaid |
$2,894.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.11
|
| Rate for Payer: Cash Price |
$4,207.76
|
| Rate for Payer: Cigna Commercial |
$6,984.88
|
| Rate for Payer: First Health Commercial |
$7,994.74
|
| Rate for Payer: Humana Commercial |
$7,153.19
|
| Rate for Payer: Humana KY Medicaid |
$2,894.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.81
|
| Rate for Payer: PHCS Commercial |
$8,078.90
|
| Rate for Payer: United Healthcare All Payer |
$7,405.66
|
|
|
G2 TIBIAL WDGE SZ 5-6 71423019
|
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 5-6 71423019
|
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 5-6 71423023
|
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 5-6 71423023
|
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 5-6 71423027
|
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
|
|
