|
G2 TIBIAL WDGE SZ 5-6 71423027
|
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 71423031
|
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 71423031
|
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 71423051
|
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 71423051
|
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 5-6 71423055
|
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 71423055
|
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 5-6 71423059
|
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 5-6 71423059
|
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 71423063
|
Facility
|
IP
|
$8,634.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.49 |
| Max. Negotiated Rate |
$8,289.14 |
| Rate for Payer: Aetna Commercial |
$6,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,734.93
|
| Rate for Payer: Cash Price |
$4,317.26
|
| Rate for Payer: Cigna Commercial |
$7,166.65
|
| Rate for Payer: First Health Commercial |
$8,202.79
|
| Rate for Payer: Humana Commercial |
$7,339.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,080.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,372.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,598.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,726.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,676.70
|
| Rate for Payer: PHCS Commercial |
$8,289.14
|
| Rate for Payer: United Healthcare All Payer |
$7,598.38
|
|
|
G2 TIBIAL WDGE SZ 5-6 71423063
|
Facility
|
OP
|
$8,634.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.49 |
| Max. Negotiated Rate |
$8,289.14 |
| Rate for Payer: Aetna Commercial |
$6,648.58
|
| Rate for Payer: Anthem Medicaid |
$2,969.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,734.93
|
| Rate for Payer: Cash Price |
$4,317.26
|
| Rate for Payer: Cigna Commercial |
$7,166.65
|
| Rate for Payer: First Health Commercial |
$8,202.79
|
| Rate for Payer: Humana Commercial |
$7,339.34
|
| Rate for Payer: Humana KY Medicaid |
$2,969.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,999.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,080.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,372.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,028.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,598.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,726.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,676.70
|
| Rate for Payer: PHCS Commercial |
$8,289.14
|
| Rate for Payer: United Healthcare All Payer |
$7,598.38
|
|
|
G2 TIBIAL WDGE SZ 7-8 71423020
|
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 7-8 71423020
|
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 7-8 71423024
|
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 7-8 71423024
|
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 7-8 71423028
|
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 7-8 71423028
|
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 7-8 71423032
|
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 7-8 71423032
|
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 7-8 71423052
|
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 7-8 71423052
|
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 7-8 71423056
|
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 7-8 71423056
|
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 7-8 71423060
|
Facility
|
OP
|
$8,634.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.49 |
| Max. Negotiated Rate |
$8,289.14 |
| Rate for Payer: Aetna Commercial |
$6,648.58
|
| Rate for Payer: Anthem Medicaid |
$2,969.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,734.93
|
| Rate for Payer: Cash Price |
$4,317.26
|
| Rate for Payer: Cigna Commercial |
$7,166.65
|
| Rate for Payer: First Health Commercial |
$8,202.79
|
| Rate for Payer: Humana Commercial |
$7,339.34
|
| Rate for Payer: Humana KY Medicaid |
$2,969.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,999.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,080.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,372.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,028.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,598.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,726.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,676.70
|
| Rate for Payer: PHCS Commercial |
$8,289.14
|
| Rate for Payer: United Healthcare All Payer |
$7,598.38
|
|
|
G2 TIBIAL WDGE SZ 7-8 71423060
|
Facility
|
IP
|
$8,634.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.49 |
| Max. Negotiated Rate |
$8,289.14 |
| Rate for Payer: Aetna Commercial |
$6,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,734.93
|
| Rate for Payer: Cash Price |
$4,317.26
|
| Rate for Payer: Cigna Commercial |
$7,166.65
|
| Rate for Payer: First Health Commercial |
$8,202.79
|
| Rate for Payer: Humana Commercial |
$7,339.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,080.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,372.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,598.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,726.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,676.70
|
| Rate for Payer: PHCS Commercial |
$8,289.14
|
| Rate for Payer: United Healthcare All Payer |
$7,598.38
|
|
