|
TC3 PFC SIGMA FEM SZ 5 L
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 5 R
|
Facility
|
IP
|
$68,912.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,958.66 |
| Max. Negotiated Rate |
$66,156.29 |
| Rate for Payer: Aetna Commercial |
$53,062.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,751.98
|
| Rate for Payer: Cash Price |
$34,456.40
|
| Rate for Payer: Cigna Commercial |
$57,197.62
|
| Rate for Payer: First Health Commercial |
$65,467.16
|
| Rate for Payer: Humana Commercial |
$58,575.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,508.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,857.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,673.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,643.26
|
| Rate for Payer: Ohio Health Group HMO |
$51,684.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,782.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,958.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,362.97
|
| Rate for Payer: PHCS Commercial |
$66,156.29
|
| Rate for Payer: United Healthcare All Payer |
$60,643.26
|
|
|
TC3 PFC SIGMA FEM SZ 5 R
|
Facility
|
OP
|
$68,912.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,958.66 |
| Max. Negotiated Rate |
$66,156.29 |
| Rate for Payer: Aetna Commercial |
$53,062.86
|
| Rate for Payer: Anthem Medicaid |
$23,699.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,751.98
|
| Rate for Payer: Cash Price |
$34,456.40
|
| Rate for Payer: Cigna Commercial |
$57,197.62
|
| Rate for Payer: First Health Commercial |
$65,467.16
|
| Rate for Payer: Humana Commercial |
$58,575.88
|
| Rate for Payer: Humana KY Medicaid |
$23,699.11
|
| Rate for Payer: Kentucky WC Medicaid |
$23,940.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,508.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,857.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,673.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,174.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,643.26
|
| Rate for Payer: Ohio Health Group HMO |
$51,684.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,782.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,958.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,362.97
|
| Rate for Payer: PHCS Commercial |
$66,156.29
|
| Rate for Payer: United Healthcare All Payer |
$60,643.26
|
|
|
TC3 PFC TIBIAL INSRT SZ 12.5MM
|
Facility
|
OP
|
$12,866.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.66 |
| Max. Negotiated Rate |
$12,351.98 |
| Rate for Payer: Aetna Commercial |
$9,907.32
|
| Rate for Payer: Anthem Medicaid |
$4,424.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,035.99
|
| Rate for Payer: Cash Price |
$6,433.32
|
| Rate for Payer: Cigna Commercial |
$10,679.32
|
| Rate for Payer: First Health Commercial |
$12,223.32
|
| Rate for Payer: Humana Commercial |
$10,936.65
|
| Rate for Payer: Humana KY Medicaid |
$4,424.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,469.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,550.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,495.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,860.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,513.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,322.65
|
| Rate for Payer: Ohio Health Group HMO |
$9,649.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,573.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,672.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,988.66
|
| Rate for Payer: PHCS Commercial |
$12,351.98
|
| Rate for Payer: United Healthcare All Payer |
$11,322.65
|
|
|
TC3 PFC TIBIAL INSRT SZ 12.5MM
|
Facility
|
IP
|
$12,866.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.66 |
| Max. Negotiated Rate |
$12,351.98 |
| Rate for Payer: Aetna Commercial |
$9,907.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,035.99
|
| Rate for Payer: Cash Price |
$6,433.32
|
| Rate for Payer: Cigna Commercial |
$10,679.32
|
| Rate for Payer: First Health Commercial |
$12,223.32
|
| Rate for Payer: Humana Commercial |
$10,936.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,550.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,495.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,860.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,322.65
|
| Rate for Payer: Ohio Health Group HMO |
$9,649.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,573.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,672.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,988.66
|
| Rate for Payer: PHCS Commercial |
$12,351.98
|
| Rate for Payer: United Healthcare All Payer |
$11,322.65
|
|
|
TC3 RP TIBIAL INSERT SZ 2*10.0
|
Facility
|
IP
|
$22,199.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,885.94 |
| Max. Negotiated Rate |
$21,311.57 |
| Rate for Payer: Aetna Commercial |
$17,093.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,315.65
|
| Rate for Payer: Cash Price |
$11,099.77
|
| Rate for Payer: Cigna Commercial |
$18,425.63
|
| Rate for Payer: First Health Commercial |
$21,089.57
|
| Rate for Payer: Humana Commercial |
$18,869.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,383.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,659.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,535.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,649.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,439.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,885.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,881.86
|
| Rate for Payer: PHCS Commercial |
$21,311.57
|
| Rate for Payer: United Healthcare All Payer |
$19,535.60
|
|
|
TC3 RP TIBIAL INSERT SZ 2*10.0
|
Facility
|
OP
|
$22,199.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,885.94 |
| Max. Negotiated Rate |
$21,311.57 |
| Rate for Payer: Aetna Commercial |
$17,093.65
|
| Rate for Payer: Anthem Medicaid |
$7,634.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,315.65
|
| Rate for Payer: Cash Price |
$11,099.77
|
| Rate for Payer: Cigna Commercial |
$18,425.63
|
| Rate for Payer: First Health Commercial |
$21,089.57
|
| Rate for Payer: Humana Commercial |
$18,869.62
|
| Rate for Payer: Humana KY Medicaid |
$7,634.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,712.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,383.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,659.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,787.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,535.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,649.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,439.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,885.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,881.86
|
| Rate for Payer: PHCS Commercial |
$21,311.57
|
| Rate for Payer: United Healthcare All Payer |
$19,535.60
|
|
|
TC3 RP TIBIAL INSERT SZ 2*12.5
|
Facility
|
OP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem Medicaid |
$5,979.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Humana KY Medicaid |
$5,979.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,040.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,099.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2*12.5
|
Facility
|
IP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2*15.0
|
Facility
|
IP
|
$20,286.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.30 |
| Max. Negotiated Rate |
$19,475.47 |
| Rate for Payer: Aetna Commercial |
$15,620.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,823.82
|
| Rate for Payer: Cash Price |
$10,143.48
|
| Rate for Payer: Cigna Commercial |
$16,838.17
|
| Rate for Payer: First Health Commercial |
$19,272.60
|
| Rate for Payer: Humana Commercial |
$17,243.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,635.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,971.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,086.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,852.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,215.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.95
|
| Rate for Payer: PHCS Commercial |
$19,475.47
|
| Rate for Payer: United Healthcare All Payer |
$17,852.52
|
|
|
TC3 RP TIBIAL INSERT SZ 2*15.0
|
Facility
|
OP
|
$20,286.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.30 |
| Max. Negotiated Rate |
$19,475.47 |
| Rate for Payer: Aetna Commercial |
$15,620.95
|
| Rate for Payer: Anthem Medicaid |
$6,976.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,823.82
|
| Rate for Payer: Cash Price |
$10,143.48
|
| Rate for Payer: Cigna Commercial |
$16,838.17
|
| Rate for Payer: First Health Commercial |
$19,272.60
|
| Rate for Payer: Humana Commercial |
$17,243.91
|
| Rate for Payer: Humana KY Medicaid |
$6,976.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,047.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,635.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,971.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,086.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,116.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,852.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,215.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.95
|
| Rate for Payer: PHCS Commercial |
$19,475.47
|
| Rate for Payer: United Healthcare All Payer |
$17,852.52
|
|
|
TC3 RP TIBIAL INSERT SZ 2*17.5
|
Facility
|
OP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem Medicaid |
$7,257.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Humana KY Medicaid |
$7,257.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,331.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,403.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
|
TC3 RP TIBIAL INSERT SZ 2*17.5
|
Facility
|
IP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
|
TC3 RP TIBIAL INSERT SZ 2*20.0
|
Facility
|
OP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem Medicaid |
$7,257.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Humana KY Medicaid |
$7,257.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,331.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,403.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
|
TC3 RP TIBIAL INSERT SZ 2*20.0
|
Facility
|
IP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
|
TC3 RP TIBIAL INSERT SZ 2*22.5
|
Facility
|
OP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem Medicaid |
$5,979.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Humana KY Medicaid |
$5,979.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,040.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,099.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2*22.5
|
Facility
|
IP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2*25.0
|
Facility
|
IP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2*25.0
|
Facility
|
OP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem Medicaid |
$5,979.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Humana KY Medicaid |
$5,979.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,040.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,099.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2*30.0
|
Facility
|
IP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2*30.0
|
Facility
|
OP
|
$17,388.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.53 |
| Max. Negotiated Rate |
$16,693.12 |
| Rate for Payer: Aetna Commercial |
$13,389.28
|
| Rate for Payer: Anthem Medicaid |
$5,979.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,563.16
|
| Rate for Payer: Cash Price |
$8,694.34
|
| Rate for Payer: Cigna Commercial |
$14,432.60
|
| Rate for Payer: First Health Commercial |
$16,519.24
|
| Rate for Payer: Humana Commercial |
$14,780.37
|
| Rate for Payer: Humana KY Medicaid |
$5,979.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,040.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,258.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,832.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,216.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,099.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,302.03
|
| Rate for Payer: Ohio Health Group HMO |
$13,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,477.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,390.49
|
| Rate for Payer: PHCS Commercial |
$16,693.12
|
| Rate for Payer: United Healthcare All Payer |
$15,302.03
|
|
|
TC3 RP TIBIAL INSERT SZ 2.5*10
|
Facility
|
IP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
|
TC3 RP TIBIAL INSERT SZ 2.5*10
|
Facility
|
OP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem Medicaid |
$7,257.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Humana KY Medicaid |
$7,257.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,331.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,403.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
|
TC3 RP TIBIAL INSERT SZ 2.5*12
|
Facility
|
IP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
|
TC3 RP TIBIAL INSERT SZ 2.5*12
|
Facility
|
OP
|
$21,103.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,743.47 |
| Max. Negotiated Rate |
$20,259.49 |
| Rate for Payer: Aetna Commercial |
$16,249.80
|
| Rate for Payer: Anthem Medicaid |
$7,257.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,460.84
|
| Rate for Payer: Cash Price |
$10,551.82
|
| Rate for Payer: Cigna Commercial |
$17,516.02
|
| Rate for Payer: First Health Commercial |
$20,048.46
|
| Rate for Payer: Humana Commercial |
$17,938.09
|
| Rate for Payer: Humana KY Medicaid |
$7,257.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,331.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,304.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,574.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,331.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,403.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,827.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,743.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,542.13
|
| Rate for Payer: PHCS Commercial |
$20,259.49
|
| Rate for Payer: United Healthcare All Payer |
$18,571.20
|
|
