|
TC3 RP TIBIAL INSERT SZ 4*15.0
|
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 4*15.0
|
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 4*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 4*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 4*20.0
|
Facility
|
OP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem Medicaid |
$8,496.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Humana KY Medicaid |
$8,496.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,582.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,666.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
TC3 RP TIBIAL INSERT SZ 4*20.0
|
Facility
|
IP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
TC3 RP TIBIAL INSERT SZ 4*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 4*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 4*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 4*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 4*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 4*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 5*10.0
|
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 5*10.0
|
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 5*12.5
|
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 5*12.5
|
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 5*15.0
|
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 5*15.0
|
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 5*17.5
|
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 5*17.5
|
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 5*20.0
|
Facility
|
IP
|
$16,502.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,950.81 |
| Max. Negotiated Rate |
$15,842.59 |
| Rate for Payer: Aetna Commercial |
$12,707.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,872.11
|
| Rate for Payer: Cash Price |
$8,251.35
|
| Rate for Payer: Cigna Commercial |
$13,697.24
|
| Rate for Payer: First Health Commercial |
$15,677.57
|
| Rate for Payer: Humana Commercial |
$14,027.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,532.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,178.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,950.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,522.38
|
| Rate for Payer: Ohio Health Group HMO |
$12,377.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,202.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,357.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,386.86
|
| Rate for Payer: PHCS Commercial |
$15,842.59
|
| Rate for Payer: United Healthcare All Payer |
$14,522.38
|
|
|
TC3 RP TIBIAL INSERT SZ 5*20.0
|
Facility
|
OP
|
$16,502.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,950.81 |
| Max. Negotiated Rate |
$15,842.59 |
| Rate for Payer: Aetna Commercial |
$12,707.08
|
| Rate for Payer: Anthem Medicaid |
$5,675.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,872.11
|
| Rate for Payer: Cash Price |
$8,251.35
|
| Rate for Payer: Cigna Commercial |
$13,697.24
|
| Rate for Payer: First Health Commercial |
$15,677.57
|
| Rate for Payer: Humana Commercial |
$14,027.30
|
| Rate for Payer: Humana KY Medicaid |
$5,675.28
|
| Rate for Payer: Kentucky WC Medicaid |
$5,733.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,532.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,178.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,950.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,789.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,522.38
|
| Rate for Payer: Ohio Health Group HMO |
$12,377.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,202.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,357.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,386.86
|
| Rate for Payer: PHCS Commercial |
$15,842.59
|
| Rate for Payer: United Healthcare All Payer |
$14,522.38
|
|
|
TC3 RP TIBIAL INSERT SZ 5*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 5*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 5*25.0
|
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
|
|
