|
TC3 RP TIBIAL INSERT SZ 4*15.0
|
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 4*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 4*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 4*20.0
|
Facility
|
IP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
TC3 RP TIBIAL INSERT SZ 4*20.0
|
Facility
|
OP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem Medicaid |
$8,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Humana KY Medicaid |
$8,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
TC3 RP TIBIAL INSERT SZ 4*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 4*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 4*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 4*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 4*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 4*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 5*10.0
|
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 5*10.0
|
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 5*12.5
|
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 5*12.5
|
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 5*15.0
|
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 5*15.0
|
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 5*17.5
|
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 5*17.5
|
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 5*20.0
|
Facility
|
IP
|
$15,975.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,076.83 |
| Max. Negotiated Rate |
$15,336.58 |
| Rate for Payer: Aetna Commercial |
$12,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,460.97
|
| Rate for Payer: Cash Price |
$7,987.80
|
| Rate for Payer: Cigna Commercial |
$13,259.75
|
| Rate for Payer: First Health Commercial |
$15,176.82
|
| Rate for Payer: Humana Commercial |
$13,579.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,099.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,789.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,792.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,058.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,981.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,195.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,952.44
|
| Rate for Payer: PHCS Commercial |
$15,336.58
|
| Rate for Payer: United Healthcare All Payer |
$14,058.53
|
|
|
TC3 RP TIBIAL INSERT SZ 5*20.0
|
Facility
|
OP
|
$15,975.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,076.83 |
| Max. Negotiated Rate |
$15,336.58 |
| Rate for Payer: Aetna Commercial |
$12,301.21
|
| Rate for Payer: Anthem Medicaid |
$5,494.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,460.97
|
| Rate for Payer: Cash Price |
$7,987.80
|
| Rate for Payer: Cigna Commercial |
$13,259.75
|
| Rate for Payer: First Health Commercial |
$15,176.82
|
| Rate for Payer: Humana Commercial |
$13,579.26
|
| Rate for Payer: Humana KY Medicaid |
$5,494.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,549.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,099.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,789.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,792.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,604.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,058.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,981.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,195.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,952.44
|
| Rate for Payer: PHCS Commercial |
$15,336.58
|
| Rate for Payer: United Healthcare All Payer |
$14,058.53
|
|
|
TC3 RP TIBIAL INSERT SZ 5*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 5*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 5*25.0
|
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 5*25.0
|
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
|
|
