|
TIBIAL BEARING POLY OSS 14MM
|
Facility
|
IP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 14MM
|
Facility
|
OP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem Medicaid |
$3,037.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Humana KY Medicaid |
$3,037.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,068.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,098.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 16MM
|
Facility
|
OP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem Medicaid |
$3,037.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Humana KY Medicaid |
$3,037.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,068.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,098.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 16MM
|
Facility
|
IP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 18MM
|
Facility
|
OP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem Medicaid |
$3,037.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Humana KY Medicaid |
$3,037.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,068.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,098.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 18MM
|
Facility
|
IP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 20MM
|
Facility
|
OP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem Medicaid |
$3,037.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Humana KY Medicaid |
$3,037.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,068.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,098.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 20MM
|
Facility
|
IP
|
$8,833.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.31 |
| Max. Negotiated Rate |
$8,479.80 |
| Rate for Payer: Aetna Commercial |
$6,801.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,889.83
|
| Rate for Payer: Cash Price |
$4,416.56
|
| Rate for Payer: Cigna Commercial |
$7,331.49
|
| Rate for Payer: First Health Commercial |
$8,391.46
|
| Rate for Payer: Humana Commercial |
$7,508.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,243.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,518.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,649.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,773.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,624.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.27
|
| Rate for Payer: PHCS Commercial |
$8,479.80
|
| Rate for Payer: United Healthcare All Payer |
$7,773.15
|
|
|
TIBIAL BEARING POLY OSS 22MM
|
Facility
|
IP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL BEARING POLY OSS 22MM
|
Facility
|
OP
|
$9,334.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.54 |
| Max. Negotiated Rate |
$8,961.56 |
| Rate for Payer: Aetna Commercial |
$7,187.92
|
| Rate for Payer: Anthem Medicaid |
$3,210.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,281.27
|
| Rate for Payer: Cash Price |
$4,667.48
|
| Rate for Payer: Cigna Commercial |
$7,748.02
|
| Rate for Payer: First Health Commercial |
$8,868.21
|
| Rate for Payer: Humana Commercial |
$7,934.72
|
| Rate for Payer: Humana KY Medicaid |
$3,210.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,654.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,889.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,214.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,001.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.84
|
| Rate for Payer: PHCS Commercial |
$8,961.56
|
| Rate for Payer: United Healthcare All Payer |
$8,214.76
|
|
|
TIBIAL BEARNG INSRT OSS RS12MM
|
Facility
|
OP
|
$7,858.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.60 |
| Max. Negotiated Rate |
$7,544.12 |
| Rate for Payer: Aetna Commercial |
$6,051.01
|
| Rate for Payer: Anthem Medicaid |
$2,702.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.60
|
| Rate for Payer: Cash Price |
$3,929.23
|
| Rate for Payer: Cigna Commercial |
$6,522.52
|
| Rate for Payer: First Health Commercial |
$7,465.54
|
| Rate for Payer: Humana Commercial |
$6,679.69
|
| Rate for Payer: Humana KY Medicaid |
$2,702.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.12
|
| Rate for Payer: PHCS Commercial |
$7,544.12
|
| Rate for Payer: United Healthcare All Payer |
$6,915.44
|
|
|
TIBIAL BEARNG INSRT OSS RS12MM
|
Facility
|
IP
|
$7,858.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.60 |
| Max. Negotiated Rate |
$7,544.12 |
| Rate for Payer: Aetna Commercial |
$6,051.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.60
|
| Rate for Payer: Cash Price |
$3,929.23
|
| Rate for Payer: Cigna Commercial |
$6,522.52
|
| Rate for Payer: First Health Commercial |
$7,465.54
|
| Rate for Payer: Humana Commercial |
$6,679.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.12
|
| Rate for Payer: PHCS Commercial |
$7,544.12
|
| Rate for Payer: United Healthcare All Payer |
$6,915.44
|
|
|
TIBIAL BEARNG INSRT OSS RS14MM
|
Facility
|
IP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS14MM
|
Facility
|
OP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,848.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Humana KY Medicaid |
$2,848.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS16MM
|
Facility
|
OP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,848.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Humana KY Medicaid |
$2,848.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS16MM
|
Facility
|
IP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS18MM
|
Facility
|
OP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,848.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Humana KY Medicaid |
$2,848.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS18MM
|
Facility
|
IP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS20MM
|
Facility
|
IP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS20MM
|
Facility
|
OP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,848.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Humana KY Medicaid |
$2,848.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS22MM
|
Facility
|
IP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BEARNG INSRT OSS RS22MM
|
Facility
|
OP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,848.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Humana KY Medicaid |
$2,848.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
TIBIAL BIOMET CC CRUCIATE 59MM
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 59MM
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 63MM
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
