|
TIBIAL BIOMET CC I-BEAM 79MM
|
Facility
|
IP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BIOMET CC I-BEAM 79MM
|
Facility
|
OP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem Medicaid |
$2,499.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Humana KY Medicaid |
$2,499.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BIOMET CC I-BEAM 83MM
|
Facility
|
OP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem Medicaid |
$2,499.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Humana KY Medicaid |
$2,499.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BIOMET CC I-BEAM 83MM
|
Facility
|
IP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BIOMET CC I-BEAM 87MM
|
Facility
|
OP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem Medicaid |
$2,499.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Humana KY Medicaid |
$2,499.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BIOMET CC I-BEAM 87MM
|
Facility
|
IP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BIOMET CC I-BEAM 91MM
|
Facility
|
IP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BIOMET CC I-BEAM 91MM
|
Facility
|
OP
|
$7,267.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.79 |
| Max. Negotiated Rate |
$6,976.90 |
| Rate for Payer: Aetna Commercial |
$5,596.05
|
| Rate for Payer: Anthem Medicaid |
$2,499.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.73
|
| Rate for Payer: Cash Price |
$3,633.80
|
| Rate for Payer: Cigna Commercial |
$6,032.11
|
| Rate for Payer: First Health Commercial |
$6,904.22
|
| Rate for Payer: Humana Commercial |
$6,177.46
|
| Rate for Payer: Humana KY Medicaid |
$2,499.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.96
|
| Rate for Payer: PHCS Commercial |
$6,976.90
|
| Rate for Payer: United Healthcare All Payer |
$6,395.49
|
|
|
TIBIAL BLCKAUG RS20*47/51ML/LR
|
Facility
|
OP
|
$8,480.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.51 |
| Max. Negotiated Rate |
$8,141.63 |
| Rate for Payer: Aetna Commercial |
$6,530.26
|
| Rate for Payer: Anthem Medicaid |
$2,916.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,615.07
|
| Rate for Payer: Cash Price |
$4,240.43
|
| Rate for Payer: Cigna Commercial |
$7,039.11
|
| Rate for Payer: First Health Commercial |
$8,056.82
|
| Rate for Payer: Humana Commercial |
$7,208.73
|
| Rate for Payer: Humana KY Medicaid |
$2,916.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,946.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,954.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,258.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,975.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,463.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,360.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.07
|
| Rate for Payer: PHCS Commercial |
$8,141.63
|
| Rate for Payer: United Healthcare All Payer |
$7,463.16
|
|
|
TIBIAL BLCKAUG RS20*47/51ML/LR
|
Facility
|
IP
|
$8,480.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.51 |
| Max. Negotiated Rate |
$8,141.63 |
| Rate for Payer: Aetna Commercial |
$6,530.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,615.07
|
| Rate for Payer: Cash Price |
$4,240.43
|
| Rate for Payer: Cigna Commercial |
$7,039.11
|
| Rate for Payer: First Health Commercial |
$8,056.82
|
| Rate for Payer: Humana Commercial |
$7,208.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,954.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,258.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,463.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,360.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.07
|
| Rate for Payer: PHCS Commercial |
$8,141.63
|
| Rate for Payer: United Healthcare All Payer |
$7,463.16
|
|
|
TIBIAL BLCKAUG RS20*55/59ML/LR
|
Facility
|
OP
|
$8,480.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.51 |
| Max. Negotiated Rate |
$8,141.63 |
| Rate for Payer: Aetna Commercial |
$6,530.26
|
| Rate for Payer: Anthem Medicaid |
$2,916.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,615.07
|
| Rate for Payer: Cash Price |
$4,240.43
|
| Rate for Payer: Cigna Commercial |
$7,039.11
|
| Rate for Payer: First Health Commercial |
$8,056.82
|
| Rate for Payer: Humana Commercial |
$7,208.73
|
| Rate for Payer: Humana KY Medicaid |
$2,916.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,946.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,954.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,258.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,975.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,463.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,360.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.07
|
| Rate for Payer: PHCS Commercial |
$8,141.63
|
| Rate for Payer: United Healthcare All Payer |
$7,463.16
|
|
|
TIBIAL BLCKAUG RS20*55/59ML/LR
|
Facility
|
IP
|
$8,480.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.51 |
| Max. Negotiated Rate |
$8,141.63 |
| Rate for Payer: Aetna Commercial |
$6,530.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,615.07
|
| Rate for Payer: Cash Price |
$4,240.43
|
| Rate for Payer: Cigna Commercial |
$7,039.11
|
| Rate for Payer: First Health Commercial |
$8,056.82
|
| Rate for Payer: Humana Commercial |
$7,208.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,954.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,258.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,463.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,360.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.07
|
| Rate for Payer: PHCS Commercial |
$8,141.63
|
| Rate for Payer: United Healthcare All Payer |
$7,463.16
|
|
|
TIBIAL BLCKAUG RS20*55/59MR/LL
|
Facility
|
IP
|
$8,480.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.51 |
| Max. Negotiated Rate |
$8,141.63 |
| Rate for Payer: Aetna Commercial |
$6,530.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,615.07
|
| Rate for Payer: Cash Price |
$4,240.43
|
| Rate for Payer: Cigna Commercial |
$7,039.11
|
| Rate for Payer: First Health Commercial |
$8,056.82
|
| Rate for Payer: Humana Commercial |
$7,208.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,954.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,258.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,463.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,360.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.07
|
| Rate for Payer: PHCS Commercial |
$8,141.63
|
| Rate for Payer: United Healthcare All Payer |
$7,463.16
|
|
|
TIBIAL BLCKAUG RS20*55/59MR/LL
|
Facility
|
OP
|
$8,480.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.51 |
| Max. Negotiated Rate |
$8,141.63 |
| Rate for Payer: Aetna Commercial |
$6,530.26
|
| Rate for Payer: Anthem Medicaid |
$2,916.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,615.07
|
| Rate for Payer: Cash Price |
$4,240.43
|
| Rate for Payer: Cigna Commercial |
$7,039.11
|
| Rate for Payer: First Health Commercial |
$8,056.82
|
| Rate for Payer: Humana Commercial |
$7,208.73
|
| Rate for Payer: Humana KY Medicaid |
$2,916.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,946.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,954.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,258.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,975.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,463.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,360.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.07
|
| Rate for Payer: PHCS Commercial |
$8,141.63
|
| Rate for Payer: United Healthcare All Payer |
$7,463.16
|
|
|
TIBIAL BODY PROX OSS ELLPT 9CM
|
Facility
|
OP
|
$74,760.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,718.88 |
| Max. Negotiated Rate |
$71,770.21 |
| Rate for Payer: Aetna Commercial |
$57,565.69
|
| Rate for Payer: Anthem Medicaid |
$25,710.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,313.30
|
| Rate for Payer: Cash Price |
$37,380.32
|
| Rate for Payer: Cigna Commercial |
$62,051.33
|
| Rate for Payer: First Health Commercial |
$71,022.61
|
| Rate for Payer: Humana Commercial |
$63,546.54
|
| Rate for Payer: Humana KY Medicaid |
$25,710.18
|
| Rate for Payer: Kentucky WC Medicaid |
$25,971.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,303.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,173.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,428.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,226.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,789.36
|
| Rate for Payer: Ohio Health Group HMO |
$56,070.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,952.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,718.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,175.80
|
| Rate for Payer: PHCS Commercial |
$71,770.21
|
| Rate for Payer: United Healthcare All Payer |
$65,789.36
|
|
|
TIBIAL BODY PROX OSS ELLPT 9CM
|
Facility
|
IP
|
$74,760.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,718.88 |
| Max. Negotiated Rate |
$71,770.21 |
| Rate for Payer: Aetna Commercial |
$57,565.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,313.30
|
| Rate for Payer: Cash Price |
$37,380.32
|
| Rate for Payer: Cigna Commercial |
$62,051.33
|
| Rate for Payer: First Health Commercial |
$71,022.61
|
| Rate for Payer: Humana Commercial |
$63,546.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,303.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,173.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,428.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,789.36
|
| Rate for Payer: Ohio Health Group HMO |
$56,070.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,952.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,718.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,175.80
|
| Rate for Payer: PHCS Commercial |
$71,770.21
|
| Rate for Payer: United Healthcare All Payer |
$65,789.36
|
|
|
TIBIAL BUSHING OSS POLY
|
Facility
|
IP
|
$3,743.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.70 |
| Max. Negotiated Rate |
$3,594.10 |
| Rate for Payer: Aetna Commercial |
$2,882.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,920.20
|
| Rate for Payer: Cash Price |
$1,871.92
|
| Rate for Payer: Cigna Commercial |
$3,107.40
|
| Rate for Payer: First Health Commercial |
$3,556.66
|
| Rate for Payer: Humana Commercial |
$3,182.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,069.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,294.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,807.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.59
|
| Rate for Payer: PHCS Commercial |
$3,594.10
|
| Rate for Payer: United Healthcare All Payer |
$3,294.59
|
|
|
TIBIAL BUSHING OSS POLY
|
Facility
|
OP
|
$3,743.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.70 |
| Max. Negotiated Rate |
$3,594.10 |
| Rate for Payer: Aetna Commercial |
$2,882.76
|
| Rate for Payer: Anthem Medicaid |
$1,287.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,920.20
|
| Rate for Payer: Cash Price |
$1,871.92
|
| Rate for Payer: Cigna Commercial |
$3,107.40
|
| Rate for Payer: First Health Commercial |
$3,556.66
|
| Rate for Payer: Humana Commercial |
$3,182.27
|
| Rate for Payer: Humana KY Medicaid |
$1,287.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,300.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,069.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,313.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,294.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,807.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.59
|
| Rate for Payer: PHCS Commercial |
$3,594.10
|
| Rate for Payer: United Healthcare All Payer |
$3,294.59
|
|
|
TIBIAL CEM MBT REV SZ 2
|
Facility
|
IP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 2
|
Facility
|
OP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem Medicaid |
$11,128.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Humana KY Medicaid |
$11,128.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 2.5
|
Facility
|
IP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 2.5
|
Facility
|
OP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem Medicaid |
$11,128.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Humana KY Medicaid |
$11,128.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 3
|
Facility
|
IP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 3
|
Facility
|
OP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem Medicaid |
$11,128.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Humana KY Medicaid |
$11,128.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL CEM MBT REV SZ 4
|
Facility
|
IP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
