|
TIBIAL BASE LEG HK SZ 2 RT
|
Facility
|
OP
|
$24,963.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,488.94 |
| Max. Negotiated Rate |
$23,964.60 |
| Rate for Payer: Aetna Commercial |
$19,221.60
|
| Rate for Payer: Anthem Medicaid |
$8,584.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,471.23
|
| Rate for Payer: Cash Price |
$12,481.56
|
| Rate for Payer: Cigna Commercial |
$20,719.39
|
| Rate for Payer: First Health Commercial |
$23,714.96
|
| Rate for Payer: Humana Commercial |
$21,218.65
|
| Rate for Payer: Humana KY Medicaid |
$8,584.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,672.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,422.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,488.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,757.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,967.55
|
| Rate for Payer: Ohio Health Group HMO |
$18,722.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,970.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,717.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,224.55
|
| Rate for Payer: PHCS Commercial |
$23,964.60
|
| Rate for Payer: United Healthcare All Payer |
$21,967.55
|
|
|
TIBIAL BASE LEG HK SZ 3 RT
|
Facility
|
IP
|
$24,963.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,488.94 |
| Max. Negotiated Rate |
$23,964.60 |
| Rate for Payer: Aetna Commercial |
$19,221.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,471.23
|
| Rate for Payer: Cash Price |
$12,481.56
|
| Rate for Payer: Cigna Commercial |
$20,719.39
|
| Rate for Payer: First Health Commercial |
$23,714.96
|
| Rate for Payer: Humana Commercial |
$21,218.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,422.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,488.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,967.55
|
| Rate for Payer: Ohio Health Group HMO |
$18,722.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,970.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,717.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,224.55
|
| Rate for Payer: PHCS Commercial |
$23,964.60
|
| Rate for Payer: United Healthcare All Payer |
$21,967.55
|
|
|
TIBIAL BASE LEG HK SZ 3 RT
|
Facility
|
OP
|
$24,963.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,488.94 |
| Max. Negotiated Rate |
$23,964.60 |
| Rate for Payer: Aetna Commercial |
$19,221.60
|
| Rate for Payer: Anthem Medicaid |
$8,584.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,471.23
|
| Rate for Payer: Cash Price |
$12,481.56
|
| Rate for Payer: Cigna Commercial |
$20,719.39
|
| Rate for Payer: First Health Commercial |
$23,714.96
|
| Rate for Payer: Humana Commercial |
$21,218.65
|
| Rate for Payer: Humana KY Medicaid |
$8,584.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,672.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,422.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,488.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,757.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,967.55
|
| Rate for Payer: Ohio Health Group HMO |
$18,722.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,970.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,717.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,224.55
|
| Rate for Payer: PHCS Commercial |
$23,964.60
|
| Rate for Payer: United Healthcare All Payer |
$21,967.55
|
|
|
TIBIAL BASE LEG HK SZ 4 RT
|
Facility
|
IP
|
$24,963.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,488.94 |
| Max. Negotiated Rate |
$23,964.60 |
| Rate for Payer: Aetna Commercial |
$19,221.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,471.23
|
| Rate for Payer: Cash Price |
$12,481.56
|
| Rate for Payer: Cigna Commercial |
$20,719.39
|
| Rate for Payer: First Health Commercial |
$23,714.96
|
| Rate for Payer: Humana Commercial |
$21,218.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,422.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,488.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,967.55
|
| Rate for Payer: Ohio Health Group HMO |
$18,722.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,970.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,717.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,224.55
|
| Rate for Payer: PHCS Commercial |
$23,964.60
|
| Rate for Payer: United Healthcare All Payer |
$21,967.55
|
|
|
TIBIAL BASE LEG HK SZ 4 RT
|
Facility
|
OP
|
$24,963.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,488.94 |
| Max. Negotiated Rate |
$23,964.60 |
| Rate for Payer: Aetna Commercial |
$19,221.60
|
| Rate for Payer: Anthem Medicaid |
$8,584.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,471.23
|
| Rate for Payer: Cash Price |
$12,481.56
|
| Rate for Payer: Cigna Commercial |
$20,719.39
|
| Rate for Payer: First Health Commercial |
$23,714.96
|
| Rate for Payer: Humana Commercial |
$21,218.65
|
| Rate for Payer: Humana KY Medicaid |
$8,584.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,672.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,422.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,488.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,757.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,967.55
|
| Rate for Payer: Ohio Health Group HMO |
$18,722.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,970.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,717.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,224.55
|
| Rate for Payer: PHCS Commercial |
$23,964.60
|
| Rate for Payer: United Healthcare All Payer |
$21,967.55
|
|
|
TIBIAL BASE LEG HK SZ 5 RT
|
Facility
|
OP
|
$24,963.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,488.94 |
| Max. Negotiated Rate |
$23,964.60 |
| Rate for Payer: Aetna Commercial |
$19,221.60
|
| Rate for Payer: Anthem Medicaid |
$8,584.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,471.23
|
| Rate for Payer: Cash Price |
$12,481.56
|
| Rate for Payer: Cigna Commercial |
$20,719.39
|
| Rate for Payer: First Health Commercial |
$23,714.96
|
| Rate for Payer: Humana Commercial |
$21,218.65
|
| Rate for Payer: Humana KY Medicaid |
$8,584.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,672.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,422.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,488.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,757.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,967.55
|
| Rate for Payer: Ohio Health Group HMO |
$18,722.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,970.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,717.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,224.55
|
| Rate for Payer: PHCS Commercial |
$23,964.60
|
| Rate for Payer: United Healthcare All Payer |
$21,967.55
|
|
|
TIBIAL BASE LEG HK SZ 5 RT
|
Facility
|
IP
|
$24,963.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,488.94 |
| Max. Negotiated Rate |
$23,964.60 |
| Rate for Payer: Aetna Commercial |
$19,221.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,471.23
|
| Rate for Payer: Cash Price |
$12,481.56
|
| Rate for Payer: Cigna Commercial |
$20,719.39
|
| Rate for Payer: First Health Commercial |
$23,714.96
|
| Rate for Payer: Humana Commercial |
$21,218.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,422.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,488.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,967.55
|
| Rate for Payer: Ohio Health Group HMO |
$18,722.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,970.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,717.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,224.55
|
| Rate for Payer: PHCS Commercial |
$23,964.60
|
| Rate for Payer: United Healthcare All Payer |
$21,967.55
|
|
|
TIBIAL BASE LEG HK SZ 7 RT
|
Facility
|
IP
|
$22,666.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,799.88 |
| Max. Negotiated Rate |
$21,759.60 |
| Rate for Payer: Aetna Commercial |
$17,453.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,679.67
|
| Rate for Payer: Cash Price |
$11,333.12
|
| Rate for Payer: Cigna Commercial |
$18,812.99
|
| Rate for Payer: First Health Commercial |
$21,532.94
|
| Rate for Payer: Humana Commercial |
$19,266.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,586.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,727.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,799.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,946.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,999.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,719.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,639.71
|
| Rate for Payer: PHCS Commercial |
$21,759.60
|
| Rate for Payer: United Healthcare All Payer |
$19,946.30
|
|
|
TIBIAL BASE LEG HK SZ 7 RT
|
Facility
|
OP
|
$22,666.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,799.88 |
| Max. Negotiated Rate |
$21,759.60 |
| Rate for Payer: Aetna Commercial |
$17,453.01
|
| Rate for Payer: Anthem Medicaid |
$7,794.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,679.67
|
| Rate for Payer: Cash Price |
$11,333.12
|
| Rate for Payer: Cigna Commercial |
$18,812.99
|
| Rate for Payer: First Health Commercial |
$21,532.94
|
| Rate for Payer: Humana Commercial |
$19,266.31
|
| Rate for Payer: Humana KY Medicaid |
$7,794.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,874.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,586.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,727.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,799.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,951.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,946.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,999.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,719.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,639.71
|
| Rate for Payer: PHCS Commercial |
$21,759.60
|
| Rate for Payer: United Healthcare All Payer |
$19,946.30
|
|
|
TIBIAL BASE PLATE OSS LONG 63
|
Facility
|
IP
|
$24,000.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.09 |
| Max. Negotiated Rate |
$23,040.30 |
| Rate for Payer: Aetna Commercial |
$18,480.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,720.24
|
| Rate for Payer: Cash Price |
$12,000.16
|
| Rate for Payer: Cigna Commercial |
$19,920.26
|
| Rate for Payer: First Health Commercial |
$22,800.29
|
| Rate for Payer: Humana Commercial |
$20,400.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,680.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,712.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,200.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,120.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,000.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,200.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,880.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,560.21
|
| Rate for Payer: PHCS Commercial |
$23,040.30
|
| Rate for Payer: United Healthcare All Payer |
$21,120.27
|
|
|
TIBIAL BASE PLATE OSS LONG 63
|
Facility
|
OP
|
$24,000.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.09 |
| Max. Negotiated Rate |
$23,040.30 |
| Rate for Payer: Aetna Commercial |
$18,480.24
|
| Rate for Payer: Anthem Medicaid |
$8,253.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,720.24
|
| Rate for Payer: Cash Price |
$12,000.16
|
| Rate for Payer: Cigna Commercial |
$19,920.26
|
| Rate for Payer: First Health Commercial |
$22,800.29
|
| Rate for Payer: Humana Commercial |
$20,400.26
|
| Rate for Payer: Humana KY Medicaid |
$8,253.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,337.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,680.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,712.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,200.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,419.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,120.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,000.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,200.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,880.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,560.21
|
| Rate for Payer: PHCS Commercial |
$23,040.30
|
| Rate for Payer: United Healthcare All Payer |
$21,120.27
|
|
|
TIBIAL BASE PLATE OSS LONG 67
|
Facility
|
OP
|
$24,000.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.09 |
| Max. Negotiated Rate |
$23,040.30 |
| Rate for Payer: Aetna Commercial |
$18,480.24
|
| Rate for Payer: Anthem Medicaid |
$8,253.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,720.24
|
| Rate for Payer: Cash Price |
$12,000.16
|
| Rate for Payer: Cigna Commercial |
$19,920.26
|
| Rate for Payer: First Health Commercial |
$22,800.29
|
| Rate for Payer: Humana Commercial |
$20,400.26
|
| Rate for Payer: Humana KY Medicaid |
$8,253.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,337.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,680.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,712.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,200.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,419.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,120.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,000.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,200.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,880.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,560.21
|
| Rate for Payer: PHCS Commercial |
$23,040.30
|
| Rate for Payer: United Healthcare All Payer |
$21,120.27
|
|
|
TIBIAL BASE PLATE OSS LONG 67
|
Facility
|
IP
|
$24,000.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.09 |
| Max. Negotiated Rate |
$23,040.30 |
| Rate for Payer: Aetna Commercial |
$18,480.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,720.24
|
| Rate for Payer: Cash Price |
$12,000.16
|
| Rate for Payer: Cigna Commercial |
$19,920.26
|
| Rate for Payer: First Health Commercial |
$22,800.29
|
| Rate for Payer: Humana Commercial |
$20,400.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,680.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,712.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,200.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,120.27
|
| Rate for Payer: Ohio Health Group HMO |
$18,000.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,200.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,880.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,560.21
|
| Rate for Payer: PHCS Commercial |
$23,040.30
|
| Rate for Payer: United Healthcare All Payer |
$21,120.27
|
|
|
TIBIAL BASE PLATE OSS MOD 63MM
|
Facility
|
IP
|
$25,515.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,654.67 |
| Max. Negotiated Rate |
$24,494.96 |
| Rate for Payer: Aetna Commercial |
$19,647.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,902.15
|
| Rate for Payer: Cash Price |
$12,757.79
|
| Rate for Payer: Cigna Commercial |
$21,177.93
|
| Rate for Payer: First Health Commercial |
$24,239.80
|
| Rate for Payer: Humana Commercial |
$21,688.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,922.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,830.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,654.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,453.71
|
| Rate for Payer: Ohio Health Group HMO |
$19,136.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,412.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,198.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,605.75
|
| Rate for Payer: PHCS Commercial |
$24,494.96
|
| Rate for Payer: United Healthcare All Payer |
$22,453.71
|
|
|
TIBIAL BASE PLATE OSS MOD 63MM
|
Facility
|
OP
|
$25,515.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,654.67 |
| Max. Negotiated Rate |
$24,494.96 |
| Rate for Payer: Aetna Commercial |
$19,647.00
|
| Rate for Payer: Anthem Medicaid |
$8,774.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,902.15
|
| Rate for Payer: Cash Price |
$12,757.79
|
| Rate for Payer: Cigna Commercial |
$21,177.93
|
| Rate for Payer: First Health Commercial |
$24,239.80
|
| Rate for Payer: Humana Commercial |
$21,688.24
|
| Rate for Payer: Humana KY Medicaid |
$8,774.81
|
| Rate for Payer: Kentucky WC Medicaid |
$8,864.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,922.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,830.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,654.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,950.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,453.71
|
| Rate for Payer: Ohio Health Group HMO |
$19,136.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,412.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,198.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,605.75
|
| Rate for Payer: PHCS Commercial |
$24,494.96
|
| Rate for Payer: United Healthcare All Payer |
$22,453.71
|
|
|
TIBIAL BASE PLATE OSS MOD 67MM
|
Facility
|
IP
|
$26,024.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,807.20 |
| Max. Negotiated Rate |
$24,983.04 |
| Rate for Payer: Aetna Commercial |
$20,038.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,298.72
|
| Rate for Payer: Cash Price |
$13,012.00
|
| Rate for Payer: Cigna Commercial |
$21,599.92
|
| Rate for Payer: First Health Commercial |
$24,722.80
|
| Rate for Payer: Humana Commercial |
$22,120.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,339.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,205.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,807.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,901.12
|
| Rate for Payer: Ohio Health Group HMO |
$19,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,819.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,640.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,956.56
|
| Rate for Payer: PHCS Commercial |
$24,983.04
|
| Rate for Payer: United Healthcare All Payer |
$22,901.12
|
|
|
TIBIAL BASE PLATE OSS MOD 67MM
|
Facility
|
OP
|
$26,024.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,807.20 |
| Max. Negotiated Rate |
$24,983.04 |
| Rate for Payer: Aetna Commercial |
$20,038.48
|
| Rate for Payer: Anthem Medicaid |
$8,949.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,298.72
|
| Rate for Payer: Cash Price |
$13,012.00
|
| Rate for Payer: Cigna Commercial |
$21,599.92
|
| Rate for Payer: First Health Commercial |
$24,722.80
|
| Rate for Payer: Humana Commercial |
$22,120.40
|
| Rate for Payer: Humana KY Medicaid |
$8,949.65
|
| Rate for Payer: Kentucky WC Medicaid |
$9,040.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,339.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,205.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,807.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,129.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,901.12
|
| Rate for Payer: Ohio Health Group HMO |
$19,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,819.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,640.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,956.56
|
| Rate for Payer: PHCS Commercial |
$24,983.04
|
| Rate for Payer: United Healthcare All Payer |
$22,901.12
|
|
|
TIBIAL BASE PLATE OSS MOD 71MM
|
Facility
|
IP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
|
TIBIAL BASE PLATE OSS MOD 71MM
|
Facility
|
OP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem Medicaid |
$8,371.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Humana KY Medicaid |
$8,371.80
|
| Rate for Payer: Kentucky WC Medicaid |
$8,457.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,539.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
|
TIBIAL BASE PLATE OSS MOD 75MM
|
Facility
|
OP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem Medicaid |
$8,371.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Humana KY Medicaid |
$8,371.80
|
| Rate for Payer: Kentucky WC Medicaid |
$8,457.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,539.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
|
TIBIAL BASE PLATE OSS MOD 75MM
|
Facility
|
IP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
|
TIBIAL BASE PLATE OSS MOD 79MM
|
Facility
|
IP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
|
TIBIAL BASE PLATE OSS MOD 79MM
|
Facility
|
OP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem Medicaid |
$8,371.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Humana KY Medicaid |
$8,371.80
|
| Rate for Payer: Kentucky WC Medicaid |
$8,457.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,539.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
|
TIBIAL BASE PLATE OSS MOD 83MM
|
Facility
|
IP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
|
TIBIAL BASE PLATE OSS MOD 83MM
|
Facility
|
OP
|
$24,343.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$23,369.95 |
| Rate for Payer: Aetna Commercial |
$18,744.65
|
| Rate for Payer: Anthem Medicaid |
$8,371.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,988.09
|
| Rate for Payer: Cash Price |
$12,171.85
|
| Rate for Payer: Cigna Commercial |
$20,205.27
|
| Rate for Payer: First Health Commercial |
$23,126.51
|
| Rate for Payer: Humana Commercial |
$20,692.15
|
| Rate for Payer: Humana KY Medicaid |
$8,371.80
|
| Rate for Payer: Kentucky WC Medicaid |
$8,457.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,961.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,965.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,303.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,539.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,422.46
|
| Rate for Payer: Ohio Health Group HMO |
$18,257.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,179.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,797.15
|
| Rate for Payer: PHCS Commercial |
$23,369.95
|
| Rate for Payer: United Healthcare All Payer |
$21,422.46
|
|
