|
TIBIAL BEARNG INSRT OSS RS14MM
|
Facility
|
OP
|
$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 Medicaid |
$2,917.57
|
| 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: Humana KY Medicaid |
$2,917.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.26
|
| 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: Molina Healthcare Medicaid |
$2,976.10
|
| 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
|
|
|
TIBIAL BEARNG INSRT OSS RS16MM
|
Facility
|
OP
|
$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 Medicaid |
$2,917.57
|
| 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: Humana KY Medicaid |
$2,917.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.26
|
| 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: Molina Healthcare Medicaid |
$2,976.10
|
| 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
|
|
|
TIBIAL BEARNG INSRT OSS RS16MM
|
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
|
|
|
TIBIAL BEARNG INSRT OSS RS18MM
|
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
|
|
|
TIBIAL BEARNG INSRT OSS RS18MM
|
Facility
|
OP
|
$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 Medicaid |
$2,917.57
|
| 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: Humana KY Medicaid |
$2,917.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.26
|
| 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: Molina Healthcare Medicaid |
$2,976.10
|
| 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
|
|
|
TIBIAL BEARNG INSRT OSS RS20MM
|
Facility
|
OP
|
$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 Medicaid |
$2,917.57
|
| 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: Humana KY Medicaid |
$2,917.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.26
|
| 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: Molina Healthcare Medicaid |
$2,976.10
|
| 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
|
|
|
TIBIAL BEARNG INSRT OSS RS20MM
|
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
|
|
|
TIBIAL BEARNG INSRT OSS RS22MM
|
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
|
|
|
TIBIAL BEARNG INSRT OSS RS22MM
|
Facility
|
OP
|
$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 Medicaid |
$2,917.57
|
| 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: Humana KY Medicaid |
$2,917.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.26
|
| 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: Molina Healthcare Medicaid |
$2,976.10
|
| 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
|
|
|
TIBIAL BIOMET CC CRUCIATE 59MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 59MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 63MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 63MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 67MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 67MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 71MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 71MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 75MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 75MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 79MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 79MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 83MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 83MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 87MM
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
TIBIAL BIOMET CC CRUCIATE 87MM
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
