|
TC3 RP TIBIAL INSERT SZ 5*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*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ2.5*20.0
|
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 INSRT SZ2.5*20.0
|
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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 TIBIAL INSERT
|
Facility
|
OP
|
$11,841.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.33 |
| Max. Negotiated Rate |
$11,367.36 |
| Rate for Payer: Aetna Commercial |
$9,117.57
|
| Rate for Payer: Anthem Medicaid |
$4,072.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,235.98
|
| Rate for Payer: Cash Price |
$5,920.50
|
| Rate for Payer: Cigna Commercial |
$9,828.03
|
| Rate for Payer: First Health Commercial |
$11,248.95
|
| Rate for Payer: Humana Commercial |
$10,064.85
|
| Rate for Payer: Humana KY Medicaid |
$4,072.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,113.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,709.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,738.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,552.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,153.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,420.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,880.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,368.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,670.71
|
| Rate for Payer: PHCS Commercial |
$11,367.36
|
| Rate for Payer: United Healthcare All Payer |
$10,420.08
|
|
|
TC3 TIBIAL INSERT
|
Facility
|
IP
|
$11,841.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.33 |
| Max. Negotiated Rate |
$11,367.36 |
| Rate for Payer: Aetna Commercial |
$9,117.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,235.98
|
| Rate for Payer: Cash Price |
$5,920.50
|
| Rate for Payer: Cigna Commercial |
$9,828.03
|
| Rate for Payer: First Health Commercial |
$11,248.95
|
| Rate for Payer: Humana Commercial |
$10,064.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,709.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,738.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,552.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,420.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,880.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,368.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,670.71
|
| Rate for Payer: PHCS Commercial |
$11,367.36
|
| Rate for Payer: United Healthcare All Payer |
$10,420.08
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34000055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
340T0055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34000055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
340T0055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
TC 99M ARCITUMOMAB PER VIAL
|
Facility
|
IP
|
$2,054.00
|
|
|
Service Code
|
HCPCS A9568
|
| Hospital Charge Code |
34000068
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$267.02 |
| Max. Negotiated Rate |
$1,971.84 |
| Rate for Payer: Aetna Commercial |
$1,581.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,602.12
|
| Rate for Payer: Cash Price |
$1,027.00
|
| Rate for Payer: Cigna Commercial |
$1,704.82
|
| Rate for Payer: First Health Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial |
$1,745.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,684.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,515.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,807.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,540.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.74
|
| Rate for Payer: PHCS Commercial |
$1,971.84
|
| Rate for Payer: United Healthcare All Payer |
$1,807.52
|
|
|
TC 99M ARCITUMOMAB PER VIAL
|
Facility
|
OP
|
$2,054.00
|
|
|
Service Code
|
HCPCS A9568
|
| Hospital Charge Code |
34000068
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$267.02 |
| Max. Negotiated Rate |
$1,971.84 |
| Rate for Payer: Aetna Commercial |
$1,581.58
|
| Rate for Payer: Anthem Medicaid |
$706.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,602.12
|
| Rate for Payer: Cash Price |
$1,027.00
|
| Rate for Payer: Cigna Commercial |
$1,704.82
|
| Rate for Payer: First Health Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial |
$1,745.90
|
| Rate for Payer: Humana KY Medicaid |
$706.37
|
| Rate for Payer: Kentucky WC Medicaid |
$713.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,684.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,515.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$720.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,807.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,540.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.74
|
| Rate for Payer: PHCS Commercial |
$1,971.84
|
| Rate for Payer: United Healthcare All Payer |
$1,807.52
|
|
|
TC 99M EXAMETAZIME PER DOSE
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34000069
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,735.68 |
| Rate for Payer: Aetna Commercial |
$1,392.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.24
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cigna Commercial |
$1,500.64
|
| Rate for Payer: First Health Commercial |
$1,717.60
|
| Rate for Payer: Humana Commercial |
$1,536.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.48
|
| Rate for Payer: PHCS Commercial |
$1,735.68
|
| Rate for Payer: United Healthcare All Payer |
$1,591.04
|
|
