|
TC3 RP TIBIAL INSERT SZ 5*25.0
|
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*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 5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ1.5*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 INSRT SZ2.5*20.0
|
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 INSRT SZ2.5*20.0
|
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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 INSRT SZ2.5*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 TIBIAL INSERT
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
TC3 TIBIAL INSERT
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
340T0055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Professional
|
Both
|
$354.00
|
|
| Hospital Charge Code |
34000055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$247.80 |
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Multiplan PHCS |
$212.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.80
|
| Rate for Payer: UHCCP Medicaid |
$123.90
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
340T0055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34000055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
TC99M ALBUMIN AGGR EA STDYDOSE
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34000055
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
TC 99M ARCITUMOMAB PER VIAL
|
Facility
|
OP
|
$2,054.00
|
|
|
Service Code
|
HCPCS A9568
|
| Hospital Charge Code |
34000068
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$706.37 |
| Max. Negotiated Rate |
$1,971.84 |
| Rate for Payer: Aetna Commercial |
$1,581.58
|
| Rate for Payer: Anthem Medicaid |
$706.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$809.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,602.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,133.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,092.84
|
| Rate for Payer: Cash Price |
$1,027.00
|
| Rate for Payer: Cash Price |
$1,027.00
|
| Rate for Payer: Cigna Commercial |
$1,704.82
|
| Rate for Payer: First Health Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial |
$1,745.90
|
| Rate for Payer: Humana KY Medicaid |
$706.37
|
| Rate for Payer: Humana Medicare Advantage |
$809.51
|
| Rate for Payer: Kentucky WC Medicaid |
$713.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,684.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,515.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$720.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,807.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,540.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.26
|
| Rate for Payer: PHCS Commercial |
$1,971.84
|
| Rate for Payer: United Healthcare All Payer |
$1,807.52
|
|
