|
TIBIAL INSERT FLEX PS #9 18
|
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 #9 18
|
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 #9 21
|
Facility
|
OP
|
$7,758.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.56 |
| Max. Negotiated Rate |
$7,447.83 |
| Rate for Payer: Aetna Commercial |
$5,973.78
|
| Rate for Payer: Anthem Medicaid |
$2,668.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,051.36
|
| Rate for Payer: Cash Price |
$3,879.08
|
| Rate for Payer: Cigna Commercial |
$6,439.27
|
| Rate for Payer: First Health Commercial |
$7,370.25
|
| Rate for Payer: Humana Commercial |
$6,594.44
|
| Rate for Payer: Humana KY Medicaid |
$2,668.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,695.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,725.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,721.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,827.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,551.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.03
|
| Rate for Payer: PHCS Commercial |
$7,447.83
|
| Rate for Payer: United Healthcare All Payer |
$6,827.18
|
|
|
TIBIAL INSERT FLEX PS #9 21
|
Facility
|
IP
|
$7,758.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.56 |
| Max. Negotiated Rate |
$7,447.83 |
| Rate for Payer: Aetna Commercial |
$5,973.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,051.36
|
| Rate for Payer: Cash Price |
$3,879.08
|
| Rate for Payer: Cigna Commercial |
$6,439.27
|
| Rate for Payer: First Health Commercial |
$7,370.25
|
| Rate for Payer: Humana Commercial |
$6,594.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,725.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,827.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,551.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.03
|
| Rate for Payer: PHCS Commercial |
$7,447.83
|
| Rate for Payer: United Healthcare All Payer |
$6,827.18
|
|
|
TIBIAL INSERT FLEX PS #9 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 #9 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
|
|
|
TIBIAL INSERT FLEX PS #9 8
|
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 #9 8
|
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 X3 #7 8MM
|
Facility
|
IP
|
$16,263.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,114.27 |
| Max. Negotiated Rate |
$15,613.06 |
| Rate for Payer: Aetna Commercial |
$12,522.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,685.61
|
| Rate for Payer: Cash Price |
$8,131.80
|
| Rate for Payer: Cigna Commercial |
$13,498.79
|
| Rate for Payer: First Health Commercial |
$15,450.42
|
| Rate for Payer: Humana Commercial |
$13,824.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,336.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,002.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,879.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,311.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,197.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,252.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,114.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.72
|
| Rate for Payer: PHCS Commercial |
$15,613.06
|
| Rate for Payer: United Healthcare All Payer |
$14,311.97
|
|
|
TIBIAL INSERT FLEX X3 #7 8MM
|
Facility
|
OP
|
$16,263.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,114.27 |
| Max. Negotiated Rate |
$15,613.06 |
| Rate for Payer: Aetna Commercial |
$12,522.97
|
| Rate for Payer: Anthem Medicaid |
$5,593.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,685.61
|
| Rate for Payer: Cash Price |
$8,131.80
|
| Rate for Payer: Cigna Commercial |
$13,498.79
|
| Rate for Payer: First Health Commercial |
$15,450.42
|
| Rate for Payer: Humana Commercial |
$13,824.06
|
| Rate for Payer: Humana KY Medicaid |
$5,593.05
|
| Rate for Payer: Kentucky WC Medicaid |
$5,649.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,336.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,002.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,879.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,705.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,311.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,197.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,252.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,114.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.72
|
| Rate for Payer: PHCS Commercial |
$15,613.06
|
| Rate for Payer: United Healthcare All Payer |
$14,311.97
|
|
|
TIBIAL INSERT FLEX X3 #9 8MM
|
Facility
|
OP
|
$10,991.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.87 |
| Max. Negotiated Rate |
$10,551.63 |
| Rate for Payer: Aetna Commercial |
$8,463.29
|
| Rate for Payer: Anthem Medicaid |
$3,779.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,573.20
|
| Rate for Payer: Cash Price |
$5,495.64
|
| Rate for Payer: Cigna Commercial |
$9,122.76
|
| Rate for Payer: First Health Commercial |
$10,441.72
|
| Rate for Payer: Humana Commercial |
$9,342.59
|
| Rate for Payer: Humana KY Medicaid |
$3,779.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,818.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,012.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,111.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,297.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,855.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$8,243.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,198.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,428.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,407.30
|
| Rate for Payer: PHCS Commercial |
$10,551.63
|
| Rate for Payer: United Healthcare All Payer |
$9,672.33
|
|
|
TIBIAL INSERT FLEX X3 #9 8MM
|
Facility
|
IP
|
$10,991.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.87 |
| Max. Negotiated Rate |
$10,551.63 |
| Rate for Payer: Aetna Commercial |
$8,463.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,573.20
|
| Rate for Payer: Cash Price |
$5,495.64
|
| Rate for Payer: Cigna Commercial |
$9,122.76
|
| Rate for Payer: First Health Commercial |
$10,441.72
|
| Rate for Payer: Humana Commercial |
$9,342.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,012.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,111.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,297.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$8,243.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,198.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,428.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,407.30
|
| Rate for Payer: PHCS Commercial |
$10,551.63
|
| Rate for Payer: United Healthcare All Payer |
$9,672.33
|
|
|
TIBIAL INSERT PFC SZ 2 10.0MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 2 10.0MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 2 12.5MM
|
Facility
|
IP
|
$14,098.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,832.86 |
| Max. Negotiated Rate |
$13,534.93 |
| Rate for Payer: Aetna Commercial |
$10,856.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,997.13
|
| Rate for Payer: Cash Price |
$7,049.44
|
| Rate for Payer: Cigna Commercial |
$11,702.08
|
| Rate for Payer: First Health Commercial |
$13,393.95
|
| Rate for Payer: Humana Commercial |
$11,984.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,561.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,404.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,229.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,407.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,574.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,819.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,832.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,370.66
|
| Rate for Payer: PHCS Commercial |
$13,534.93
|
| Rate for Payer: United Healthcare All Payer |
$12,407.02
|
|
|
TIBIAL INSERT PFC SZ 2 12.5MM
|
Facility
|
OP
|
$14,098.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,832.86 |
| Max. Negotiated Rate |
$13,534.93 |
| Rate for Payer: Aetna Commercial |
$10,856.15
|
| Rate for Payer: Anthem Medicaid |
$4,848.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,997.13
|
| Rate for Payer: Cash Price |
$7,049.44
|
| Rate for Payer: Cigna Commercial |
$11,702.08
|
| Rate for Payer: First Health Commercial |
$13,393.95
|
| Rate for Payer: Humana Commercial |
$11,984.06
|
| Rate for Payer: Humana KY Medicaid |
$4,848.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,897.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,561.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,404.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,229.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,945.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,407.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,574.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,819.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,832.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,370.66
|
| Rate for Payer: PHCS Commercial |
$13,534.93
|
| Rate for Payer: United Healthcare All Payer |
$12,407.02
|
|
|
TIBIAL INSERT PFC SZ 2 15.0MM
|
Facility
|
IP
|
$13,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.64 |
| Max. Negotiated Rate |
$12,698.88 |
| Rate for Payer: Aetna Commercial |
$10,185.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,317.84
|
| Rate for Payer: Cash Price |
$6,614.00
|
| Rate for Payer: Cigna Commercial |
$10,979.24
|
| Rate for Payer: First Health Commercial |
$12,566.60
|
| Rate for Payer: Humana Commercial |
$11,243.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,846.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,762.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,968.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,640.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,921.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,100.68
|
| Rate for Payer: PHCS Commercial |
$12,698.88
|
| Rate for Payer: United Healthcare All Payer |
$11,640.64
|
|
|
TIBIAL INSERT PFC SZ 2 15.0MM
|
Facility
|
OP
|
$13,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.64 |
| Max. Negotiated Rate |
$12,698.88 |
| Rate for Payer: Aetna Commercial |
$10,185.56
|
| Rate for Payer: Anthem Medicaid |
$4,549.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,317.84
|
| Rate for Payer: Cash Price |
$6,614.00
|
| Rate for Payer: Cigna Commercial |
$10,979.24
|
| Rate for Payer: First Health Commercial |
$12,566.60
|
| Rate for Payer: Humana Commercial |
$11,243.80
|
| Rate for Payer: Humana KY Medicaid |
$4,549.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,595.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,846.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,762.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,968.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,640.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,921.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,100.68
|
| Rate for Payer: PHCS Commercial |
$12,698.88
|
| Rate for Payer: United Healthcare All Payer |
$11,640.64
|
|
|
TIBIAL INSERT PFC SZ 2 17.5MM
|
Facility
|
IP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL INSERT PFC SZ 2 17.5MM
|
Facility
|
OP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem Medicaid |
$2,523.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Humana KY Medicaid |
$2,523.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,574.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL INSERT PFC SZ 3 15.0MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 3 15.0MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 3 17.5MM
|
Facility
|
OP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem Medicaid |
$2,435.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Humana KY Medicaid |
$2,435.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT PFC SZ 3 17.5MM
|
Facility
|
IP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT PFC SZ 4 10.0MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
