|
TIBIAL BIOMET CC CRUCIATE 91MM
|
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 91MM
|
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 I-BEAM 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 I-BEAM 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 I-BEAM 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 I-BEAM 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 I-BEAM 67MM
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 67MM
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 71MM
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 71MM
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 75MM
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 75MM
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 79MM
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 79MM
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 83MM
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 83MM
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 87MM
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 87MM
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 91MM
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BIOMET CC I-BEAM 91MM
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
TIBIAL BLCKAUG RS20*47/51ML/LR
|
Facility
|
OP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBIAL BLCKAUG RS20*47/51ML/LR
|
Facility
|
IP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBIAL BLCKAUG RS20*55/59ML/LR
|
Facility
|
OP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBIAL BLCKAUG RS20*55/59ML/LR
|
Facility
|
IP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBIAL BLCKAUG RS20*55/59MR/LL
|
Facility
|
IP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
