|
G2 TIBIAL WDGE SZ 7-8 71423064
|
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 71423064
|
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
|
|
|
G3 LAG SCREW 10.5*90 TI
|
Facility
|
OP
|
$3,608.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.16 |
| Max. Negotiated Rate |
$3,464.57 |
| Rate for Payer: Aetna Commercial |
$2,778.88
|
| Rate for Payer: Anthem Medicaid |
$1,241.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,814.97
|
| Rate for Payer: Cash Price |
$1,804.46
|
| Rate for Payer: Cigna Commercial |
$2,995.41
|
| Rate for Payer: First Health Commercial |
$3,428.48
|
| Rate for Payer: Humana Commercial |
$3,067.59
|
| Rate for Payer: Humana KY Medicaid |
$1,241.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,253.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,959.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,663.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,082.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,266.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,175.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,706.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$721.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,118.77
|
| Rate for Payer: PHCS Commercial |
$3,464.57
|
| Rate for Payer: United Healthcare All Payer |
$3,175.86
|
|
|
G3 LAG SCREW 10.5*90 TI
|
Facility
|
IP
|
$3,608.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.16 |
| Max. Negotiated Rate |
$3,464.57 |
| Rate for Payer: Aetna Commercial |
$2,778.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,814.97
|
| Rate for Payer: Cash Price |
$1,804.46
|
| Rate for Payer: Cigna Commercial |
$2,995.41
|
| Rate for Payer: First Health Commercial |
$3,428.48
|
| Rate for Payer: Humana Commercial |
$3,067.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,959.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,663.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,082.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,175.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,706.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$721.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,118.77
|
| Rate for Payer: PHCS Commercial |
$3,464.57
|
| Rate for Payer: United Healthcare All Payer |
$3,175.86
|
|
|
G3 L GAMMA KIT 11*300*130 L TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*300*130 L TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*320*130 L TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*320*130 L TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*320*130 R TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*320*130 R TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*340*130 L TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*340*130 L TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*340*130 R TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*340*130 R TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*360*130 L TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*360*130 L TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*360*130 R TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*360*130 R TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*380*130 L TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*380*130 L TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*380*130 R TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*380*130 R TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*400*130 L TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*400*130 L TI
|
Facility
|
OP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem Medicaid |
$2,549.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Humana KY Medicaid |
$2,549.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
|
G3 L GAMMA KIT 11*400*130 R TI
|
Facility
|
IP
|
$7,413.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.77 |
| Max. Negotiated Rate |
$7,117.06 |
| Rate for Payer: Aetna Commercial |
$5,708.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.61
|
| Rate for Payer: Cash Price |
$3,706.80
|
| Rate for Payer: Cigna Commercial |
$6,153.29
|
| Rate for Payer: First Health Commercial |
$7,042.92
|
| Rate for Payer: Humana Commercial |
$6,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.22
|
| Rate for Payer: PHCS Commercial |
$7,117.06
|
| Rate for Payer: United Healthcare All Payer |
$6,523.97
|
|
