|
TM RVRSE 40MM POLY LINER +6MM
|
Facility
|
OP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem Medicaid |
$1,938.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Humana KY Medicaid |
$1,938.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 40MM POLY LINER +6MM
|
Facility
|
IP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE SPACER +9 00434903909
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
TM RVRSE SPACER +9 00434903909
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
TM RVRSE SPACR +12 00434903912
|
Facility
|
IP
|
$5,341.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$694.41 |
| Max. Negotiated Rate |
$5,127.94 |
| Rate for Payer: Aetna Commercial |
$4,113.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,166.45
|
| Rate for Payer: Cash Price |
$2,670.80
|
| Rate for Payer: Cigna Commercial |
$4,433.53
|
| Rate for Payer: First Health Commercial |
$5,074.52
|
| Rate for Payer: Humana Commercial |
$4,540.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,380.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,942.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,602.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,700.61
|
| Rate for Payer: Ohio Health Group HMO |
$4,006.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,068.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,655.90
|
| Rate for Payer: PHCS Commercial |
$5,127.94
|
| Rate for Payer: United Healthcare All Payer |
$4,700.61
|
|
|
TM RVRSE SPACR +12 00434903912
|
Facility
|
OP
|
$5,341.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$694.41 |
| Max. Negotiated Rate |
$5,127.94 |
| Rate for Payer: Aetna Commercial |
$4,113.03
|
| Rate for Payer: Anthem Medicaid |
$1,836.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,166.45
|
| Rate for Payer: Cash Price |
$2,670.80
|
| Rate for Payer: Cigna Commercial |
$4,433.53
|
| Rate for Payer: First Health Commercial |
$5,074.52
|
| Rate for Payer: Humana Commercial |
$4,540.36
|
| Rate for Payer: Humana KY Medicaid |
$1,836.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,855.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,380.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,942.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,602.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,873.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,700.61
|
| Rate for Payer: Ohio Health Group HMO |
$4,006.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,068.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,655.90
|
| Rate for Payer: PHCS Commercial |
$5,127.94
|
| Rate for Payer: United Healthcare All Payer |
$4,700.61
|
|
|
TM TIBIAL CONE LARGE 51*34 L
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 51*34 L
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 51*34 R
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 51*34 R
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 55*36 L
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 55*36 L
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 55*36 R
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 55*36 R
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 60*36 L
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 60*36 L
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 60*36 R
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 60*36 R
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 67*38 L
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 67*38 L
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 67*38 R
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE LARGE 67*38 R
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE MEDIUM 31*31
|
Facility
|
IP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE MEDIUM 31*31
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
|
TM TIBIAL CONE MEDIUM 36*31
|
Facility
|
OP
|
$21,893.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.21 |
| Max. Negotiated Rate |
$21,018.14 |
| Rate for Payer: Aetna Commercial |
$16,858.30
|
| Rate for Payer: Anthem Medicaid |
$7,529.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,077.24
|
| Rate for Payer: Cash Price |
$10,946.95
|
| Rate for Payer: Cigna Commercial |
$18,171.94
|
| Rate for Payer: First Health Commercial |
$20,799.20
|
| Rate for Payer: Humana Commercial |
$18,609.82
|
| Rate for Payer: Humana KY Medicaid |
$7,529.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,953.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,568.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,266.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,420.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,787.11
|
| Rate for Payer: PHCS Commercial |
$21,018.14
|
| Rate for Payer: United Healthcare All Payer |
$19,266.63
|
|
