|
TIBIAL SLEEVE PROX OSS RS 5CM
|
Facility
|
OP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem Medicaid |
$8,710.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Humana KY Medicaid |
$8,710.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,799.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,885.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL SLEEVE PROX OSS RS 5CM
|
Facility
|
IP
|
$25,329.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.78 |
| Max. Negotiated Rate |
$24,315.90 |
| Rate for Payer: Aetna Commercial |
$19,503.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,756.67
|
| Rate for Payer: Cash Price |
$12,664.53
|
| Rate for Payer: Cigna Commercial |
$21,023.12
|
| Rate for Payer: First Health Commercial |
$24,062.61
|
| Rate for Payer: Humana Commercial |
$21,529.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,769.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,692.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,598.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,289.57
|
| Rate for Payer: Ohio Health Group HMO |
$18,996.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,292.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,852.01
|
| Rate for Payer: PHCS Commercial |
$24,315.90
|
| Rate for Payer: United Healthcare All Payer |
$22,289.57
|
|
|
TIBIAL SLEEVE PROX OSS RS 7CM
|
Facility
|
OP
|
$32,161.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.04 |
| Max. Negotiated Rate |
$30,875.39 |
| Rate for Payer: Aetna Commercial |
$24,764.63
|
| Rate for Payer: Anthem Medicaid |
$11,060.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,086.25
|
| Rate for Payer: Cash Price |
$16,080.93
|
| Rate for Payer: Cigna Commercial |
$26,694.34
|
| Rate for Payer: First Health Commercial |
$30,553.77
|
| Rate for Payer: Humana Commercial |
$27,337.58
|
| Rate for Payer: Humana KY Medicaid |
$11,060.46
|
| Rate for Payer: Kentucky WC Medicaid |
$11,173.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,735.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,648.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,282.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,302.44
|
| Rate for Payer: Ohio Health Group HMO |
$24,121.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,432.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,181.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,970.18
|
| Rate for Payer: PHCS Commercial |
$30,875.39
|
| Rate for Payer: United Healthcare All Payer |
$28,302.44
|
|
|
TIBIAL SLEEVE PROX OSS RS 7CM
|
Facility
|
IP
|
$32,161.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.04 |
| Max. Negotiated Rate |
$30,875.39 |
| Rate for Payer: Aetna Commercial |
$24,764.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,086.25
|
| Rate for Payer: Cash Price |
$16,080.93
|
| Rate for Payer: Cigna Commercial |
$26,694.34
|
| Rate for Payer: First Health Commercial |
$30,553.77
|
| Rate for Payer: Humana Commercial |
$27,337.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,735.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,648.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,302.44
|
| Rate for Payer: Ohio Health Group HMO |
$24,121.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,432.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,181.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,970.18
|
| Rate for Payer: PHCS Commercial |
$30,875.39
|
| Rate for Payer: United Healthcare All Payer |
$28,302.44
|
|
|
TIBIAL SLEEVE PROX OSS RS 9CM
|
Facility
|
IP
|
$37,671.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,897.35 |
| Max. Negotiated Rate |
$36,165.02 |
| Rate for Payer: Aetna Commercial |
$29,007.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,384.08
|
| Rate for Payer: Cash Price |
$18,835.95
|
| Rate for Payer: Cigna Commercial |
$31,267.68
|
| Rate for Payer: First Health Commercial |
$35,788.30
|
| Rate for Payer: Humana Commercial |
$32,021.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,890.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,801.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,151.27
|
| Rate for Payer: Ohio Health Group HMO |
$28,253.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,534.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,897.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,678.29
|
| Rate for Payer: PHCS Commercial |
$36,165.02
|
| Rate for Payer: United Healthcare All Payer |
$33,151.27
|
|
|
TIBIAL SLEEVE PROX OSS RS 9CM
|
Facility
|
OP
|
$37,671.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,897.35 |
| Max. Negotiated Rate |
$36,165.02 |
| Rate for Payer: Aetna Commercial |
$29,007.36
|
| Rate for Payer: Anthem Medicaid |
$12,955.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,384.08
|
| Rate for Payer: Cash Price |
$18,835.95
|
| Rate for Payer: Cigna Commercial |
$31,267.68
|
| Rate for Payer: First Health Commercial |
$35,788.30
|
| Rate for Payer: Humana Commercial |
$32,021.12
|
| Rate for Payer: Humana KY Medicaid |
$12,955.37
|
| Rate for Payer: Kentucky WC Medicaid |
$13,087.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,890.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,801.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,215.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,151.27
|
| Rate for Payer: Ohio Health Group HMO |
$28,253.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,534.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,897.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,678.29
|
| Rate for Payer: PHCS Commercial |
$36,165.02
|
| Rate for Payer: United Healthcare All Payer |
$33,151.27
|
|
|
TIBIAL STEM W/LCK BAR PLG 75MM
|
Facility
|
IP
|
$16,414.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.84 |
| Max. Negotiated Rate |
$15,757.58 |
| Rate for Payer: Aetna Commercial |
$12,638.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,803.04
|
| Rate for Payer: Cash Price |
$8,207.08
|
| Rate for Payer: Cigna Commercial |
$13,623.74
|
| Rate for Payer: First Health Commercial |
$15,593.44
|
| Rate for Payer: Humana Commercial |
$13,952.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,459.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,113.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,924.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,444.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,310.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,282.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,133.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,088.39
|
| Rate for Payer: PHCS Commercial |
$15,757.58
|
| Rate for Payer: United Healthcare All Payer |
$14,444.45
|
|
|
TIBIAL STEM W/LCK BAR PLG 75MM
|
Facility
|
OP
|
$16,414.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.84 |
| Max. Negotiated Rate |
$15,757.58 |
| Rate for Payer: Aetna Commercial |
$12,638.90
|
| Rate for Payer: Anthem Medicaid |
$5,644.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,803.04
|
| Rate for Payer: Cash Price |
$8,207.08
|
| Rate for Payer: Cigna Commercial |
$13,623.74
|
| Rate for Payer: First Health Commercial |
$15,593.44
|
| Rate for Payer: Humana Commercial |
$13,952.03
|
| Rate for Payer: Humana KY Medicaid |
$5,644.83
|
| Rate for Payer: Kentucky WC Medicaid |
$5,702.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,459.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,113.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,924.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,758.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,444.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,310.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,282.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,133.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,088.39
|
| Rate for Payer: PHCS Commercial |
$15,757.58
|
| Rate for Payer: United Healthcare All Payer |
$14,444.45
|
|
|
TIBIAL TRAY CEM MBT REV SZ 1
|
Facility
|
OP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem Medicaid |
$11,128.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Humana KY Medicaid |
$11,128.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL TRAY CEM MBT REV SZ 1
|
Facility
|
IP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
TIBIAL TRAY COMP NP SZ 1.5
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 1.5
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 2
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 2
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 2.5
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 2.5
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 4
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 4
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 5
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 5
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 6
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 6
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
TIBIAL TRAY COMP NP SZ 7
|
Facility
|
OP
|
$13,584.24
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.95 |
| Max. Negotiated Rate |
$13,040.87 |
| Rate for Payer: Aetna Commercial |
$10,459.86
|
| Rate for Payer: Anthem Medicaid |
$4,671.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.71
|
| Rate for Payer: Cash Price |
$6,792.12
|
| Rate for Payer: Cigna Commercial |
$11,274.92
|
| Rate for Payer: First Health Commercial |
$12,905.03
|
| Rate for Payer: Humana Commercial |
$11,546.60
|
| Rate for Payer: Humana KY Medicaid |
$4,671.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,719.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,139.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,025.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,954.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,188.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,211.11
|
| Rate for Payer: PHCS Commercial |
$13,040.87
|
| Rate for Payer: United Healthcare All Payer |
$11,954.13
|
|
|
TIBIAL TRAY COMP NP SZ 7
|
Facility
|
IP
|
$13,584.24
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.95 |
| Max. Negotiated Rate |
$13,040.87 |
| Rate for Payer: Aetna Commercial |
$10,459.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.71
|
| Rate for Payer: Cash Price |
$6,792.12
|
| Rate for Payer: Cigna Commercial |
$11,274.92
|
| Rate for Payer: First Health Commercial |
$12,905.03
|
| Rate for Payer: Humana Commercial |
$11,546.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,139.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,025.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,954.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,188.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,211.11
|
| Rate for Payer: PHCS Commercial |
$13,040.87
|
| Rate for Payer: United Healthcare All Payer |
$11,954.13
|
|
|
TIBIAL WEDGE LUG 10MM
|
Facility
|
OP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem Medicaid |
$1,089.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Humana KY Medicaid |
$1,089.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
