|
TIBIAL COMP OSS HYBRD PLY 67MM
|
Facility
|
IP
|
$27,037.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,514.84 |
| Max. Negotiated Rate |
$25,955.77 |
| Rate for Payer: Aetna Commercial |
$20,818.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,089.06
|
| Rate for Payer: Cash Price |
$13,518.63
|
| Rate for Payer: Cigna Commercial |
$22,440.93
|
| Rate for Payer: First Health Commercial |
$25,685.40
|
| Rate for Payer: Humana Commercial |
$22,981.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,170.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,111.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,792.79
|
| Rate for Payer: Ohio Health Group HMO |
$20,277.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,407.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,381.55
|
| Rate for Payer: PHCS Commercial |
$25,955.77
|
| Rate for Payer: United Healthcare All Payer |
$23,792.79
|
|
|
TIBIAL COMP OSS MOD BASPLT 63M
|
Facility
|
OP
|
$26,511.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,446.52 |
| Max. Negotiated Rate |
$25,451.19 |
| Rate for Payer: Aetna Commercial |
$20,413.98
|
| Rate for Payer: Anthem Medicaid |
$9,117.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,679.09
|
| Rate for Payer: Cash Price |
$13,255.83
|
| Rate for Payer: Cigna Commercial |
$22,004.68
|
| Rate for Payer: First Health Commercial |
$25,186.08
|
| Rate for Payer: Humana Commercial |
$22,534.91
|
| Rate for Payer: Humana KY Medicaid |
$9,117.36
|
| Rate for Payer: Kentucky WC Medicaid |
$9,210.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,739.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,565.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,953.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,300.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,330.26
|
| Rate for Payer: Ohio Health Group HMO |
$19,883.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,302.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,446.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,218.61
|
| Rate for Payer: PHCS Commercial |
$25,451.19
|
| Rate for Payer: United Healthcare All Payer |
$23,330.26
|
|
|
TIBIAL COMP OSS MOD BASPLT 63M
|
Facility
|
IP
|
$26,511.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,446.52 |
| Max. Negotiated Rate |
$25,451.19 |
| Rate for Payer: Aetna Commercial |
$20,413.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,679.09
|
| Rate for Payer: Cash Price |
$13,255.83
|
| Rate for Payer: Cigna Commercial |
$22,004.68
|
| Rate for Payer: First Health Commercial |
$25,186.08
|
| Rate for Payer: Humana Commercial |
$22,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,739.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,565.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,953.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,330.26
|
| Rate for Payer: Ohio Health Group HMO |
$19,883.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,302.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,446.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,218.61
|
| Rate for Payer: PHCS Commercial |
$25,451.19
|
| Rate for Payer: United Healthcare All Payer |
$23,330.26
|
|
|
TIBIAL ELEOS BASEPLATE SZ 2
|
Facility
|
IP
|
$28,138.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.95 |
| Max. Negotiated Rate |
$27,012.58 |
| Rate for Payer: Aetna Commercial |
$21,666.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,947.72
|
| Rate for Payer: Cash Price |
$14,069.05
|
| Rate for Payer: Cigna Commercial |
$23,354.62
|
| Rate for Payer: First Health Commercial |
$26,731.20
|
| Rate for Payer: Humana Commercial |
$23,917.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,073.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,765.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,441.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,761.53
|
| Rate for Payer: Ohio Health Group HMO |
$21,103.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,657.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.81
|
| Rate for Payer: PHCS Commercial |
$27,012.58
|
| Rate for Payer: United Healthcare All Payer |
$24,761.53
|
|
|
TIBIAL ELEOS BASEPLATE SZ 2
|
Facility
|
OP
|
$28,138.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.95 |
| Max. Negotiated Rate |
$27,012.58 |
| Rate for Payer: Aetna Commercial |
$21,666.34
|
| Rate for Payer: Anthem Medicaid |
$9,676.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,947.72
|
| Rate for Payer: Cash Price |
$14,069.05
|
| Rate for Payer: Cigna Commercial |
$23,354.62
|
| Rate for Payer: First Health Commercial |
$26,731.20
|
| Rate for Payer: Humana Commercial |
$23,917.38
|
| Rate for Payer: Humana KY Medicaid |
$9,676.69
|
| Rate for Payer: Kentucky WC Medicaid |
$9,775.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,073.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,765.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,441.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,870.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,761.53
|
| Rate for Payer: Ohio Health Group HMO |
$21,103.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,657.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.81
|
| Rate for Payer: PHCS Commercial |
$27,012.58
|
| Rate for Payer: United Healthcare All Payer |
$24,761.53
|
|
|
TIBIAL ELEOS BASEPLATE SZ 3
|
Facility
|
IP
|
$28,138.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.95 |
| Max. Negotiated Rate |
$27,012.58 |
| Rate for Payer: Aetna Commercial |
$21,666.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,947.72
|
| Rate for Payer: Cash Price |
$14,069.05
|
| Rate for Payer: Cigna Commercial |
$23,354.62
|
| Rate for Payer: First Health Commercial |
$26,731.20
|
| Rate for Payer: Humana Commercial |
$23,917.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,073.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,765.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,441.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,761.53
|
| Rate for Payer: Ohio Health Group HMO |
$21,103.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,657.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.81
|
| Rate for Payer: PHCS Commercial |
$27,012.58
|
| Rate for Payer: United Healthcare All Payer |
$24,761.53
|
|
|
TIBIAL ELEOS BASEPLATE SZ 3
|
Facility
|
OP
|
$28,138.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.95 |
| Max. Negotiated Rate |
$27,012.58 |
| Rate for Payer: Aetna Commercial |
$21,666.34
|
| Rate for Payer: Anthem Medicaid |
$9,676.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,947.72
|
| Rate for Payer: Cash Price |
$14,069.05
|
| Rate for Payer: Cigna Commercial |
$23,354.62
|
| Rate for Payer: First Health Commercial |
$26,731.20
|
| Rate for Payer: Humana Commercial |
$23,917.38
|
| Rate for Payer: Humana KY Medicaid |
$9,676.69
|
| Rate for Payer: Kentucky WC Medicaid |
$9,775.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,073.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,765.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,441.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,870.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,761.53
|
| Rate for Payer: Ohio Health Group HMO |
$21,103.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,657.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.81
|
| Rate for Payer: PHCS Commercial |
$27,012.58
|
| Rate for Payer: United Healthcare All Payer |
$24,761.53
|
|
|
TIBIAL ELEOS BASEPLATE SZ 4
|
Facility
|
IP
|
$28,138.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.95 |
| Max. Negotiated Rate |
$27,012.58 |
| Rate for Payer: Aetna Commercial |
$21,666.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,947.72
|
| Rate for Payer: Cash Price |
$14,069.05
|
| Rate for Payer: Cigna Commercial |
$23,354.62
|
| Rate for Payer: First Health Commercial |
$26,731.20
|
| Rate for Payer: Humana Commercial |
$23,917.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,073.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,765.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,441.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,761.53
|
| Rate for Payer: Ohio Health Group HMO |
$21,103.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,657.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.81
|
| Rate for Payer: PHCS Commercial |
$27,012.58
|
| Rate for Payer: United Healthcare All Payer |
$24,761.53
|
|
|
TIBIAL ELEOS BASEPLATE SZ 4
|
Facility
|
OP
|
$28,138.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,657.95 |
| Max. Negotiated Rate |
$27,012.58 |
| Rate for Payer: Aetna Commercial |
$21,666.34
|
| Rate for Payer: Anthem Medicaid |
$9,676.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,947.72
|
| Rate for Payer: Cash Price |
$14,069.05
|
| Rate for Payer: Cigna Commercial |
$23,354.62
|
| Rate for Payer: First Health Commercial |
$26,731.20
|
| Rate for Payer: Humana Commercial |
$23,917.38
|
| Rate for Payer: Humana KY Medicaid |
$9,676.69
|
| Rate for Payer: Kentucky WC Medicaid |
$9,775.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,073.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,765.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,441.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,870.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,761.53
|
| Rate for Payer: Ohio Health Group HMO |
$21,103.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,657.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.81
|
| Rate for Payer: PHCS Commercial |
$27,012.58
|
| Rate for Payer: United Healthcare All Payer |
$24,761.53
|
|
|
TIBIAL HINGE COMP W/ROT STOP
|
Facility
|
IP
|
$17,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.24 |
| Max. Negotiated Rate |
$16,750.08 |
| Rate for Payer: Aetna Commercial |
$13,434.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,609.44
|
| Rate for Payer: Cash Price |
$8,724.00
|
| Rate for Payer: Cigna Commercial |
$14,481.84
|
| Rate for Payer: First Health Commercial |
$16,575.60
|
| Rate for Payer: Humana Commercial |
$14,830.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,307.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,876.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,234.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,354.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,489.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,268.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,408.88
|
| Rate for Payer: PHCS Commercial |
$16,750.08
|
| Rate for Payer: United Healthcare All Payer |
$15,354.24
|
|
|
TIBIAL HINGE COMP W/ROT STOP
|
Facility
|
OP
|
$17,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.24 |
| Max. Negotiated Rate |
$16,750.08 |
| Rate for Payer: Aetna Commercial |
$13,434.96
|
| Rate for Payer: Anthem Medicaid |
$6,000.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,609.44
|
| Rate for Payer: Cash Price |
$8,724.00
|
| Rate for Payer: Cigna Commercial |
$14,481.84
|
| Rate for Payer: First Health Commercial |
$16,575.60
|
| Rate for Payer: Humana Commercial |
$14,830.80
|
| Rate for Payer: Humana KY Medicaid |
$6,000.37
|
| Rate for Payer: Kentucky WC Medicaid |
$6,061.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,307.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,876.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,234.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,120.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,354.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,489.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,268.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,408.88
|
| Rate for Payer: PHCS Commercial |
$16,750.08
|
| Rate for Payer: United Healthcare All Payer |
$15,354.24
|
|
|
TIBIAL INSERT 16MM PEG XSM
|
Facility
|
IP
|
$7,764.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.37 |
| Max. Negotiated Rate |
$7,453.79 |
| Rate for Payer: Aetna Commercial |
$5,978.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,056.20
|
| Rate for Payer: Cash Price |
$3,882.18
|
| Rate for Payer: Cigna Commercial |
$6,444.42
|
| Rate for Payer: First Health Commercial |
$7,376.14
|
| Rate for Payer: Humana Commercial |
$6,599.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,730.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.95
|
| Rate for Payer: PHCS Commercial |
$7,453.79
|
| Rate for Payer: United Healthcare All Payer |
$6,832.64
|
|
|
TIBIAL INSERT 16MM PEG XSM
|
Facility
|
OP
|
$7,764.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.37 |
| Max. Negotiated Rate |
$7,453.79 |
| Rate for Payer: Aetna Commercial |
$5,978.56
|
| Rate for Payer: Anthem Medicaid |
$2,670.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,056.20
|
| Rate for Payer: Cash Price |
$3,882.18
|
| Rate for Payer: Cigna Commercial |
$6,444.42
|
| Rate for Payer: First Health Commercial |
$7,376.14
|
| Rate for Payer: Humana Commercial |
$6,599.71
|
| Rate for Payer: Humana KY Medicaid |
$2,670.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,730.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.95
|
| Rate for Payer: PHCS Commercial |
$7,453.79
|
| Rate for Payer: United Healthcare All Payer |
$6,832.64
|
|
|
TIBIAL INSERT FLEX PS #11 10
|
Facility
|
IP
|
$7,883.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.88 |
| Max. Negotiated Rate |
$7,568.37 |
| Rate for Payer: Aetna Commercial |
$6,070.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.30
|
| Rate for Payer: Cash Price |
$3,941.86
|
| Rate for Payer: Cigna Commercial |
$6,543.49
|
| Rate for Payer: First Health Commercial |
$7,489.53
|
| Rate for Payer: Humana Commercial |
$6,701.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,443.95
|
| Rate for Payer: PHCS Commercial |
$7,568.37
|
| Rate for Payer: United Healthcare All Payer |
$6,937.67
|
|
|
TIBIAL INSERT FLEX PS #11 10
|
Facility
|
OP
|
$7,883.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.88 |
| Max. Negotiated Rate |
$7,568.37 |
| Rate for Payer: Aetna Commercial |
$6,070.46
|
| Rate for Payer: Anthem Medicaid |
$2,711.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.30
|
| Rate for Payer: Cash Price |
$3,941.86
|
| Rate for Payer: Cigna Commercial |
$6,543.49
|
| Rate for Payer: First Health Commercial |
$7,489.53
|
| Rate for Payer: Humana Commercial |
$6,701.16
|
| Rate for Payer: Humana KY Medicaid |
$2,711.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,443.95
|
| Rate for Payer: PHCS Commercial |
$7,568.37
|
| Rate for Payer: United Healthcare All Payer |
$6,937.67
|
|
|
TIBIAL INSERT FLEX PS #11 12
|
Facility
|
OP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem Medicaid |
$2,596.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Humana KY Medicaid |
$2,596.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,623.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,648.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #11 12
|
Facility
|
IP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #11 15
|
Facility
|
IP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #11 15
|
Facility
|
OP
|
$7,550.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.61 |
| Max. Negotiated Rate |
$7,248.81 |
| Rate for Payer: Aetna Commercial |
$5,814.15
|
| Rate for Payer: Anthem Medicaid |
$2,596.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,889.66
|
| Rate for Payer: Cash Price |
$3,775.42
|
| Rate for Payer: Cigna Commercial |
$6,267.20
|
| Rate for Payer: First Health Commercial |
$7,173.30
|
| Rate for Payer: Humana Commercial |
$6,418.21
|
| Rate for Payer: Humana KY Medicaid |
$2,596.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,623.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,191.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,572.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,648.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,644.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,663.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.76
|
| Rate for Payer: PHCS Commercial |
$7,248.81
|
| Rate for Payer: United Healthcare All Payer |
$6,644.74
|
|
|
TIBIAL INSERT FLEX PS #11 18
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #11 18
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #11 21
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #11 21
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #11 24
|
Facility
|
IP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
|
TIBIAL INSERT FLEX PS #11 24
|
Facility
|
OP
|
$7,092.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.01 |
| Max. Negotiated Rate |
$6,808.70 |
| Rate for Payer: Aetna Commercial |
$5,461.15
|
| Rate for Payer: Anthem Medicaid |
$2,439.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,532.07
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cigna Commercial |
$5,886.69
|
| Rate for Payer: First Health Commercial |
$6,737.78
|
| Rate for Payer: Humana Commercial |
$6,028.54
|
| Rate for Payer: Humana KY Medicaid |
$2,439.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,234.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,241.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,319.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.64
|
| Rate for Payer: PHCS Commercial |
$6,808.70
|
| Rate for Payer: United Healthcare All Payer |
$6,241.31
|
|
