|
TIBIAL BASE PLATE OSS LONG 67
|
Facility
|
OP
|
$23,293.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.17 |
| Max. Negotiated Rate |
$22,361.89 |
| Rate for Payer: Aetna Commercial |
$17,936.10
|
| Rate for Payer: Anthem Medicaid |
$8,010.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,169.04
|
| Rate for Payer: Cash Price |
$11,646.82
|
| Rate for Payer: Cigna Commercial |
$19,333.72
|
| Rate for Payer: First Health Commercial |
$22,128.96
|
| Rate for Payer: Humana Commercial |
$19,799.59
|
| Rate for Payer: Humana KY Medicaid |
$8,010.68
|
| Rate for Payer: Kentucky WC Medicaid |
$8,092.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,100.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,190.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,988.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,171.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,498.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,470.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,658.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,221.03
|
| Rate for Payer: PHCS Commercial |
$22,361.89
|
| Rate for Payer: United Healthcare All Payer |
$20,498.40
|
|
|
TIBIAL BASE PLATE OSS MOD 63MM
|
Facility
|
OP
|
$24,768.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,219.90 |
| Max. Negotiated Rate |
$23,777.75 |
| Rate for Payer: Aetna Commercial |
$19,071.74
|
| Rate for Payer: Anthem Medicaid |
$8,517.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,319.42
|
| Rate for Payer: Cash Price |
$12,384.25
|
| Rate for Payer: Cigna Commercial |
$20,557.85
|
| Rate for Payer: First Health Commercial |
$23,530.07
|
| Rate for Payer: Humana Commercial |
$21,053.22
|
| Rate for Payer: Humana KY Medicaid |
$8,517.88
|
| Rate for Payer: Kentucky WC Medicaid |
$8,604.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,310.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,279.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,430.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,688.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,796.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,576.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,953.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,219.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,678.23
|
| Rate for Payer: PHCS Commercial |
$23,777.75
|
| Rate for Payer: United Healthcare All Payer |
$21,796.27
|
|
|
TIBIAL BASE PLATE OSS MOD 63MM
|
Facility
|
IP
|
$24,768.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,219.90 |
| Max. Negotiated Rate |
$23,777.75 |
| Rate for Payer: Aetna Commercial |
$19,071.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,319.42
|
| Rate for Payer: Cash Price |
$12,384.25
|
| Rate for Payer: Cigna Commercial |
$20,557.85
|
| Rate for Payer: First Health Commercial |
$23,530.07
|
| Rate for Payer: Humana Commercial |
$21,053.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,310.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,279.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,430.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,796.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,576.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,953.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,219.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,678.23
|
| Rate for Payer: PHCS Commercial |
$23,777.75
|
| Rate for Payer: United Healthcare All Payer |
$21,796.27
|
|
|
TIBIAL BASE PLATE OSS MOD 67MM
|
Facility
|
IP
|
$25,263.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,284.24 |
| Max. Negotiated Rate |
$24,252.83 |
| Rate for Payer: Aetna Commercial |
$19,452.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,705.42
|
| Rate for Payer: Cash Price |
$12,631.68
|
| Rate for Payer: Cigna Commercial |
$20,968.59
|
| Rate for Payer: First Health Commercial |
$24,000.19
|
| Rate for Payer: Humana Commercial |
$21,473.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,715.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,644.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,579.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,231.76
|
| Rate for Payer: Ohio Health Group HMO |
$18,947.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,052.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,831.64
|
| Rate for Payer: PHCS Commercial |
$24,252.83
|
| Rate for Payer: United Healthcare All Payer |
$22,231.76
|
|
|
TIBIAL BASE PLATE OSS MOD 67MM
|
Facility
|
OP
|
$25,263.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,284.24 |
| Max. Negotiated Rate |
$24,252.83 |
| Rate for Payer: Aetna Commercial |
$19,452.79
|
| Rate for Payer: Anthem Medicaid |
$8,688.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,705.42
|
| Rate for Payer: Cash Price |
$12,631.68
|
| Rate for Payer: Cigna Commercial |
$20,968.59
|
| Rate for Payer: First Health Commercial |
$24,000.19
|
| Rate for Payer: Humana Commercial |
$21,473.86
|
| Rate for Payer: Humana KY Medicaid |
$8,688.07
|
| Rate for Payer: Kentucky WC Medicaid |
$8,776.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,715.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,644.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,579.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,862.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,231.76
|
| Rate for Payer: Ohio Health Group HMO |
$18,947.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,052.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,831.64
|
| Rate for Payer: PHCS Commercial |
$24,252.83
|
| Rate for Payer: United Healthcare All Payer |
$22,231.76
|
|
|
TIBIAL BASE PLATE OSS MOD 71MM
|
Facility
|
OP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem Medicaid |
$8,125.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Humana KY Medicaid |
$8,125.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,208.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,288.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS MOD 71MM
|
Facility
|
IP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS MOD 75MM
|
Facility
|
IP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS MOD 75MM
|
Facility
|
OP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem Medicaid |
$8,125.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Humana KY Medicaid |
$8,125.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,208.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,288.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS MOD 79MM
|
Facility
|
OP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem Medicaid |
$8,125.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Humana KY Medicaid |
$8,125.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,208.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,288.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS MOD 79MM
|
Facility
|
IP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS MOD 83MM
|
Facility
|
OP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem Medicaid |
$8,125.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Humana KY Medicaid |
$8,125.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,208.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,288.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS MOD 83MM
|
Facility
|
IP
|
$23,627.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.62 |
| Max. Negotiated Rate |
$22,682.76 |
| Rate for Payer: Aetna Commercial |
$18,193.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,429.74
|
| Rate for Payer: Cash Price |
$11,813.93
|
| Rate for Payer: Cigna Commercial |
$19,611.13
|
| Rate for Payer: First Health Commercial |
$22,446.48
|
| Rate for Payer: Humana Commercial |
$20,083.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,374.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,437.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,088.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,792.53
|
| Rate for Payer: Ohio Health Group HMO |
$17,720.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,725.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,324.64
|
| Rate for Payer: PHCS Commercial |
$22,682.76
|
| Rate for Payer: United Healthcare All Payer |
$20,792.53
|
|
|
TIBIAL BASE PLATE OSS SHORT 63
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLATE OSS SHORT 63
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLATE OSS SHORT 67
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLATE OSS SHORT 67
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLATE OSS SHORT 71
|
Facility
|
OP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem Medicaid |
$8,303.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Humana KY Medicaid |
$8,303.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,388.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,470.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLATE OSS SHORT 71
|
Facility
|
IP
|
$24,146.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.04 |
| Max. Negotiated Rate |
$23,180.60 |
| Rate for Payer: Aetna Commercial |
$18,592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,834.24
|
| Rate for Payer: Cash Price |
$12,073.23
|
| Rate for Payer: Cigna Commercial |
$20,041.56
|
| Rate for Payer: First Health Commercial |
$22,939.14
|
| Rate for Payer: Humana Commercial |
$20,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,800.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,820.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,243.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,248.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,109.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,829.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,139.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,485.40
|
| Rate for Payer: PHCS Commercial |
$23,180.60
|
| Rate for Payer: United Healthcare All Payer |
$21,248.88
|
|
|
TIBIAL BASE PLATE OSS STD 75MM
|
Facility
|
IP
|
$23,293.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.17 |
| Max. Negotiated Rate |
$22,361.89 |
| Rate for Payer: Aetna Commercial |
$17,936.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,169.04
|
| Rate for Payer: Cash Price |
$11,646.82
|
| Rate for Payer: Cigna Commercial |
$19,333.72
|
| Rate for Payer: First Health Commercial |
$22,128.96
|
| Rate for Payer: Humana Commercial |
$19,799.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,100.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,190.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,988.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,498.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,470.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,658.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,221.03
|
| Rate for Payer: PHCS Commercial |
$22,361.89
|
| Rate for Payer: United Healthcare All Payer |
$20,498.40
|
|
|
TIBIAL BASE PLATE OSS STD 75MM
|
Facility
|
OP
|
$23,293.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.17 |
| Max. Negotiated Rate |
$22,361.89 |
| Rate for Payer: Aetna Commercial |
$17,936.10
|
| Rate for Payer: Anthem Medicaid |
$8,010.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,169.04
|
| Rate for Payer: Cash Price |
$11,646.82
|
| Rate for Payer: Cigna Commercial |
$19,333.72
|
| Rate for Payer: First Health Commercial |
$22,128.96
|
| Rate for Payer: Humana Commercial |
$19,799.59
|
| Rate for Payer: Humana KY Medicaid |
$8,010.68
|
| Rate for Payer: Kentucky WC Medicaid |
$8,092.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,100.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,190.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,988.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,171.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,498.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,470.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,658.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,221.03
|
| Rate for Payer: PHCS Commercial |
$22,361.89
|
| Rate for Payer: United Healthcare All Payer |
$20,498.40
|
|
|
TIBIAL BASEPLAT HYBRD PLY 63MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIBIAL BASEPLAT HYBRD PLY 63MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIBIAL BASE PLAT OSS RS LNG 47
|
Facility
|
IP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
|
TIBIAL BASE PLAT OSS RS LNG 47
|
Facility
|
OP
|
$24,869.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.99 |
| Max. Negotiated Rate |
$23,874.39 |
| Rate for Payer: Aetna Commercial |
$19,149.25
|
| Rate for Payer: Anthem Medicaid |
$8,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,397.94
|
| Rate for Payer: Cash Price |
$12,434.58
|
| Rate for Payer: Cigna Commercial |
$20,641.40
|
| Rate for Payer: First Health Commercial |
$23,625.70
|
| Rate for Payer: Humana Commercial |
$21,138.79
|
| Rate for Payer: Humana KY Medicaid |
$8,552.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,392.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,884.86
|
| Rate for Payer: Ohio Health Group HMO |
$18,651.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,709.44
|
| Rate for Payer: PHCS Commercial |
$23,874.39
|
| Rate for Payer: United Healthcare All Payer |
$21,884.86
|
|
