|
TIBIAL BEARG VNGD PS+ 24*79/83
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBIAL BEARG VNGD PS+ 24*79/83
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBIAL BEARG VNGD PS 24*87/91
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBIAL BEARG VNGD PS 24*87/91
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBIAL BEARG VNGD PS+ 24*87/91
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBIAL BEARG VNGD PS+ 24*87/91
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBIAL BEARING E1 ANTI INFUSED
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
TIBIAL BEARING E1 ANTI INFUSED
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
TIBIAL BEARING INSERT 7 10MM
|
Facility
|
IP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TIBIAL BEARING INSERT 7 10MM
|
Facility
|
OP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem Medicaid |
$2,728.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Humana KY Medicaid |
$2,728.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,755.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,782.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TIBIAL BEARING POLY OSS 12MM
|
Facility
|
OP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem Medicaid |
$3,106.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Humana KY Medicaid |
$3,106.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,168.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 12MM
|
Facility
|
IP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 14MM
|
Facility
|
IP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 14MM
|
Facility
|
OP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem Medicaid |
$3,106.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Humana KY Medicaid |
$3,106.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,168.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 16MM
|
Facility
|
OP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem Medicaid |
$3,106.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Humana KY Medicaid |
$3,106.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,168.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 16MM
|
Facility
|
IP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 18MM
|
Facility
|
IP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 18MM
|
Facility
|
OP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem Medicaid |
$3,106.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Humana KY Medicaid |
$3,106.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,168.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 20MM
|
Facility
|
IP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 20MM
|
Facility
|
OP
|
$9,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,709.94 |
| Max. Negotiated Rate |
$8,671.80 |
| Rate for Payer: Aetna Commercial |
$6,955.50
|
| Rate for Payer: Anthem Medicaid |
$3,106.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,045.83
|
| Rate for Payer: Cash Price |
$4,516.56
|
| Rate for Payer: Cigna Commercial |
$7,497.49
|
| Rate for Payer: First Health Commercial |
$8,581.46
|
| Rate for Payer: Humana Commercial |
$7,678.15
|
| Rate for Payer: Humana KY Medicaid |
$3,106.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,138.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,407.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,666.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,709.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,168.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,949.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,774.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,226.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,858.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,232.85
|
| Rate for Payer: PHCS Commercial |
$8,671.80
|
| Rate for Payer: United Healthcare All Payer |
$7,949.15
|
|
|
TIBIAL BEARING POLY OSS 22MM
|
Facility
|
OP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem Medicaid |
$3,279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Humana KY Medicaid |
$3,279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,312.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,344.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL BEARING POLY OSS 22MM
|
Facility
|
IP
|
$9,534.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.49 |
| Max. Negotiated Rate |
$9,153.56 |
| Rate for Payer: Aetna Commercial |
$7,341.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,437.27
|
| Rate for Payer: Cash Price |
$4,767.48
|
| Rate for Payer: Cigna Commercial |
$7,914.02
|
| Rate for Payer: First Health Commercial |
$9,058.21
|
| Rate for Payer: Humana Commercial |
$8,104.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,818.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,036.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,860.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,151.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,627.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,295.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.12
|
| Rate for Payer: PHCS Commercial |
$9,153.56
|
| Rate for Payer: United Healthcare All Payer |
$8,390.76
|
|
|
TIBIAL BEARNG INSRT OSS RS12MM
|
Facility
|
IP
|
$8,058.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.54 |
| Max. Negotiated Rate |
$7,736.12 |
| Rate for Payer: Aetna Commercial |
$6,205.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,285.60
|
| Rate for Payer: Cash Price |
$4,029.23
|
| Rate for Payer: Cigna Commercial |
$6,688.52
|
| Rate for Payer: First Health Commercial |
$7,655.54
|
| Rate for Payer: Humana Commercial |
$6,849.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,947.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,091.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,560.34
|
| Rate for Payer: PHCS Commercial |
$7,736.12
|
| Rate for Payer: United Healthcare All Payer |
$7,091.44
|
|
|
TIBIAL BEARNG INSRT OSS RS12MM
|
Facility
|
OP
|
$8,058.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.54 |
| Max. Negotiated Rate |
$7,736.12 |
| Rate for Payer: Aetna Commercial |
$6,205.01
|
| Rate for Payer: Anthem Medicaid |
$2,771.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,285.60
|
| Rate for Payer: Cash Price |
$4,029.23
|
| Rate for Payer: Cigna Commercial |
$6,688.52
|
| Rate for Payer: First Health Commercial |
$7,655.54
|
| Rate for Payer: Humana Commercial |
$6,849.69
|
| Rate for Payer: Humana KY Medicaid |
$2,771.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,799.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,947.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,091.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,560.34
|
| Rate for Payer: PHCS Commercial |
$7,736.12
|
| Rate for Payer: United Healthcare All Payer |
$7,091.44
|
|
|
TIBIAL BEARNG INSRT OSS RS14MM
|
Facility
|
IP
|
$8,483.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.13 |
| Max. Negotiated Rate |
$8,144.41 |
| Rate for Payer: Aetna Commercial |
$6,532.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,617.33
|
| Rate for Payer: Cash Price |
$4,241.88
|
| Rate for Payer: Cigna Commercial |
$7,041.52
|
| Rate for Payer: First Health Commercial |
$8,059.57
|
| Rate for Payer: Humana Commercial |
$7,211.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,956.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,261.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,465.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,362.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,787.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,380.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,853.79
|
| Rate for Payer: PHCS Commercial |
$8,144.41
|
| Rate for Payer: United Healthcare All Payer |
$7,465.71
|
|
