|
TC3 PFC SIGMA FEM SZ 5 L
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 5 L
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 5 R
|
Facility
|
OP
|
$71,102.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,330.72 |
| Max. Negotiated Rate |
$68,258.30 |
| Rate for Payer: Aetna Commercial |
$54,748.85
|
| Rate for Payer: Anthem Medicaid |
$24,452.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,459.87
|
| Rate for Payer: Cash Price |
$35,551.20
|
| Rate for Payer: Cigna Commercial |
$59,014.99
|
| Rate for Payer: First Health Commercial |
$67,547.28
|
| Rate for Payer: Humana Commercial |
$60,437.04
|
| Rate for Payer: Humana KY Medicaid |
$24,452.12
|
| Rate for Payer: Kentucky WC Medicaid |
$24,700.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,303.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,473.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,330.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,942.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,570.11
|
| Rate for Payer: Ohio Health Group HMO |
$53,326.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,881.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,859.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,060.66
|
| Rate for Payer: PHCS Commercial |
$68,258.30
|
| Rate for Payer: United Healthcare All Payer |
$62,570.11
|
|
|
TC3 PFC SIGMA FEM SZ 5 R
|
Facility
|
IP
|
$71,102.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,330.72 |
| Max. Negotiated Rate |
$68,258.30 |
| Rate for Payer: Aetna Commercial |
$54,748.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,459.87
|
| Rate for Payer: Cash Price |
$35,551.20
|
| Rate for Payer: Cigna Commercial |
$59,014.99
|
| Rate for Payer: First Health Commercial |
$67,547.28
|
| Rate for Payer: Humana Commercial |
$60,437.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,303.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,473.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,330.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,570.11
|
| Rate for Payer: Ohio Health Group HMO |
$53,326.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,881.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,859.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,060.66
|
| Rate for Payer: PHCS Commercial |
$68,258.30
|
| Rate for Payer: United Healthcare All Payer |
$62,570.11
|
|
|
TC3 PFC TIBIAL INSRT SZ 12.5MM
|
Facility
|
IP
|
$13,119.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,935.72 |
| Max. Negotiated Rate |
$12,594.31 |
| Rate for Payer: Aetna Commercial |
$10,101.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.87
|
| Rate for Payer: Cash Price |
$6,559.54
|
| Rate for Payer: Cigna Commercial |
$10,888.83
|
| Rate for Payer: First Health Commercial |
$12,463.12
|
| Rate for Payer: Humana Commercial |
$11,151.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.78
|
| Rate for Payer: Ohio Health Group HMO |
$9,839.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,495.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,413.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,052.16
|
| Rate for Payer: PHCS Commercial |
$12,594.31
|
| Rate for Payer: United Healthcare All Payer |
$11,544.78
|
|
|
TC3 PFC TIBIAL INSRT SZ 12.5MM
|
Facility
|
OP
|
$13,119.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,935.72 |
| Max. Negotiated Rate |
$12,594.31 |
| Rate for Payer: Aetna Commercial |
$10,101.68
|
| Rate for Payer: Anthem Medicaid |
$4,511.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.87
|
| Rate for Payer: Cash Price |
$6,559.54
|
| Rate for Payer: Cigna Commercial |
$10,888.83
|
| Rate for Payer: First Health Commercial |
$12,463.12
|
| Rate for Payer: Humana Commercial |
$11,151.21
|
| Rate for Payer: Humana KY Medicaid |
$4,511.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,557.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,602.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.78
|
| Rate for Payer: Ohio Health Group HMO |
$9,839.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,495.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,413.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,052.16
|
| Rate for Payer: PHCS Commercial |
$12,594.31
|
| Rate for Payer: United Healthcare All Payer |
$11,544.78
|
|
|
TC3 RP TIBIAL INSERT SZ 2*10.0
|
Facility
|
IP
|
$22,876.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,862.88 |
| Max. Negotiated Rate |
$21,961.20 |
| Rate for Payer: Aetna Commercial |
$17,614.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,843.47
|
| Rate for Payer: Cash Price |
$11,438.12
|
| Rate for Payer: Cigna Commercial |
$18,987.29
|
| Rate for Payer: First Health Commercial |
$21,732.44
|
| Rate for Payer: Humana Commercial |
$19,444.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,758.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,882.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,131.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,157.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,301.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,902.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,784.61
|
| Rate for Payer: PHCS Commercial |
$21,961.20
|
| Rate for Payer: United Healthcare All Payer |
$20,131.10
|
|
|
TC3 RP TIBIAL INSERT SZ 2*10.0
|
Facility
|
OP
|
$22,876.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,862.88 |
| Max. Negotiated Rate |
$21,961.20 |
| Rate for Payer: Aetna Commercial |
$17,614.71
|
| Rate for Payer: Anthem Medicaid |
$7,867.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,843.47
|
| Rate for Payer: Cash Price |
$11,438.12
|
| Rate for Payer: Cigna Commercial |
$18,987.29
|
| Rate for Payer: First Health Commercial |
$21,732.44
|
| Rate for Payer: Humana Commercial |
$19,444.81
|
| Rate for Payer: Humana KY Medicaid |
$7,867.14
|
| Rate for Payer: Kentucky WC Medicaid |
$7,947.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,758.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,882.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,024.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,131.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,157.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,301.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,902.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,784.61
|
| Rate for Payer: PHCS Commercial |
$21,961.20
|
| Rate for Payer: United Healthcare All Payer |
$20,131.10
|
|
|
TC3 RP TIBIAL INSERT SZ 2*12.5
|
Facility
|
IP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2*12.5
|
Facility
|
OP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem Medicaid |
$6,174.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Humana KY Medicaid |
$6,174.73
|
| Rate for Payer: Kentucky WC Medicaid |
$6,237.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,298.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2*15.0
|
Facility
|
IP
|
$20,911.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,273.38 |
| Max. Negotiated Rate |
$20,074.80 |
| Rate for Payer: Aetna Commercial |
$16,101.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,310.77
|
| Rate for Payer: Cash Price |
$10,455.62
|
| Rate for Payer: Cigna Commercial |
$17,356.34
|
| Rate for Payer: First Health Commercial |
$19,865.69
|
| Rate for Payer: Humana Commercial |
$17,774.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,147.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,432.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,273.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,401.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,683.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,729.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,192.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,428.76
|
| Rate for Payer: PHCS Commercial |
$20,074.80
|
| Rate for Payer: United Healthcare All Payer |
$18,401.90
|
|
|
TC3 RP TIBIAL INSERT SZ 2*15.0
|
Facility
|
OP
|
$20,911.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,273.38 |
| Max. Negotiated Rate |
$20,074.80 |
| Rate for Payer: Aetna Commercial |
$16,101.66
|
| Rate for Payer: Anthem Medicaid |
$7,191.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,310.77
|
| Rate for Payer: Cash Price |
$10,455.62
|
| Rate for Payer: Cigna Commercial |
$17,356.34
|
| Rate for Payer: First Health Commercial |
$19,865.69
|
| Rate for Payer: Humana Commercial |
$17,774.56
|
| Rate for Payer: Humana KY Medicaid |
$7,191.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,264.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,147.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,432.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,273.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,335.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,401.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,683.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,729.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,192.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,428.76
|
| Rate for Payer: PHCS Commercial |
$20,074.80
|
| Rate for Payer: United Healthcare All Payer |
$18,401.90
|
|
|
TC3 RP TIBIAL INSERT SZ 2*17.5
|
Facility
|
OP
|
$21,750.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,525.09 |
| Max. Negotiated Rate |
$20,880.30 |
| Rate for Payer: Aetna Commercial |
$16,747.74
|
| Rate for Payer: Anthem Medicaid |
$7,479.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,965.24
|
| Rate for Payer: Cash Price |
$10,875.16
|
| Rate for Payer: Cigna Commercial |
$18,052.76
|
| Rate for Payer: First Health Commercial |
$20,662.79
|
| Rate for Payer: Humana Commercial |
$18,487.76
|
| Rate for Payer: Humana KY Medicaid |
$7,479.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,556.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,835.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,051.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,525.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,630.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,140.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,312.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,400.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,922.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,007.71
|
| Rate for Payer: PHCS Commercial |
$20,880.30
|
| Rate for Payer: United Healthcare All Payer |
$19,140.27
|
|
|
TC3 RP TIBIAL INSERT SZ 2*17.5
|
Facility
|
IP
|
$21,750.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,525.09 |
| Max. Negotiated Rate |
$20,880.30 |
| Rate for Payer: Aetna Commercial |
$16,747.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,965.24
|
| Rate for Payer: Cash Price |
$10,875.16
|
| Rate for Payer: Cigna Commercial |
$18,052.76
|
| Rate for Payer: First Health Commercial |
$20,662.79
|
| Rate for Payer: Humana Commercial |
$18,487.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,835.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,051.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,525.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,140.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,312.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,400.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,922.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,007.71
|
| Rate for Payer: PHCS Commercial |
$20,880.30
|
| Rate for Payer: United Healthcare All Payer |
$19,140.27
|
|
|
TC3 RP TIBIAL INSERT SZ 2*20.0
|
Facility
|
OP
|
$21,750.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,525.09 |
| Max. Negotiated Rate |
$20,880.30 |
| Rate for Payer: Aetna Commercial |
$16,747.74
|
| Rate for Payer: Anthem Medicaid |
$7,479.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,965.24
|
| Rate for Payer: Cash Price |
$10,875.16
|
| Rate for Payer: Cigna Commercial |
$18,052.76
|
| Rate for Payer: First Health Commercial |
$20,662.79
|
| Rate for Payer: Humana Commercial |
$18,487.76
|
| Rate for Payer: Humana KY Medicaid |
$7,479.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,556.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,835.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,051.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,525.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,630.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,140.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,312.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,400.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,922.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,007.71
|
| Rate for Payer: PHCS Commercial |
$20,880.30
|
| Rate for Payer: United Healthcare All Payer |
$19,140.27
|
|
|
TC3 RP TIBIAL INSERT SZ 2*20.0
|
Facility
|
IP
|
$21,750.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,525.09 |
| Max. Negotiated Rate |
$20,880.30 |
| Rate for Payer: Aetna Commercial |
$16,747.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,965.24
|
| Rate for Payer: Cash Price |
$10,875.16
|
| Rate for Payer: Cigna Commercial |
$18,052.76
|
| Rate for Payer: First Health Commercial |
$20,662.79
|
| Rate for Payer: Humana Commercial |
$18,487.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,835.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,051.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,525.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,140.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,312.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,400.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,922.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,007.71
|
| Rate for Payer: PHCS Commercial |
$20,880.30
|
| Rate for Payer: United Healthcare All Payer |
$19,140.27
|
|
|
TC3 RP TIBIAL INSERT SZ 2*22.5
|
Facility
|
IP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2*22.5
|
Facility
|
OP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem Medicaid |
$6,174.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Humana KY Medicaid |
$6,174.73
|
| Rate for Payer: Kentucky WC Medicaid |
$6,237.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,298.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2*25.0
|
Facility
|
IP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2*25.0
|
Facility
|
OP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem Medicaid |
$6,174.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Humana KY Medicaid |
$6,174.73
|
| Rate for Payer: Kentucky WC Medicaid |
$6,237.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,298.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2*30.0
|
Facility
|
IP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2*30.0
|
Facility
|
OP
|
$17,955.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,386.51 |
| Max. Negotiated Rate |
$17,236.82 |
| Rate for Payer: Aetna Commercial |
$13,825.37
|
| Rate for Payer: Anthem Medicaid |
$6,174.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,004.92
|
| Rate for Payer: Cash Price |
$8,977.51
|
| Rate for Payer: Cigna Commercial |
$14,902.67
|
| Rate for Payer: First Health Commercial |
$17,057.27
|
| Rate for Payer: Humana Commercial |
$15,261.77
|
| Rate for Payer: Humana KY Medicaid |
$6,174.73
|
| Rate for Payer: Kentucky WC Medicaid |
$6,237.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,386.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,298.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,800.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,466.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,364.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,620.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,388.96
|
| Rate for Payer: PHCS Commercial |
$17,236.82
|
| Rate for Payer: United Healthcare All Payer |
$15,800.42
|
|
|
TC3 RP TIBIAL INSERT SZ 2.5*10
|
Facility
|
IP
|
$21,750.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,525.09 |
| Max. Negotiated Rate |
$20,880.30 |
| Rate for Payer: Aetna Commercial |
$16,747.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,965.24
|
| Rate for Payer: Cash Price |
$10,875.16
|
| Rate for Payer: Cigna Commercial |
$18,052.76
|
| Rate for Payer: First Health Commercial |
$20,662.79
|
| Rate for Payer: Humana Commercial |
$18,487.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,835.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,051.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,525.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,140.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,312.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,400.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,922.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,007.71
|
| Rate for Payer: PHCS Commercial |
$20,880.30
|
| Rate for Payer: United Healthcare All Payer |
$19,140.27
|
|
|
TC3 RP TIBIAL INSERT SZ 2.5*10
|
Facility
|
OP
|
$21,750.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,525.09 |
| Max. Negotiated Rate |
$20,880.30 |
| Rate for Payer: Aetna Commercial |
$16,747.74
|
| Rate for Payer: Anthem Medicaid |
$7,479.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,965.24
|
| Rate for Payer: Cash Price |
$10,875.16
|
| Rate for Payer: Cigna Commercial |
$18,052.76
|
| Rate for Payer: First Health Commercial |
$20,662.79
|
| Rate for Payer: Humana Commercial |
$18,487.76
|
| Rate for Payer: Humana KY Medicaid |
$7,479.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,556.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,835.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,051.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,525.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,630.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,140.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,312.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,400.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,922.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,007.71
|
| Rate for Payer: PHCS Commercial |
$20,880.30
|
| Rate for Payer: United Healthcare All Payer |
$19,140.27
|
|
|
TC3 RP TIBIAL INSERT SZ 2.5*12
|
Facility
|
OP
|
$21,750.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,525.09 |
| Max. Negotiated Rate |
$20,880.30 |
| Rate for Payer: Aetna Commercial |
$16,747.74
|
| Rate for Payer: Anthem Medicaid |
$7,479.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,965.24
|
| Rate for Payer: Cash Price |
$10,875.16
|
| Rate for Payer: Cigna Commercial |
$18,052.76
|
| Rate for Payer: First Health Commercial |
$20,662.79
|
| Rate for Payer: Humana Commercial |
$18,487.76
|
| Rate for Payer: Humana KY Medicaid |
$7,479.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,556.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,835.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,051.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,525.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,630.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,140.27
|
| Rate for Payer: Ohio Health Group HMO |
$16,312.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,400.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,922.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,007.71
|
| Rate for Payer: PHCS Commercial |
$20,880.30
|
| Rate for Payer: United Healthcare All Payer |
$19,140.27
|
|
