|
TIBIAL COMP OSS AVL YOKE 14MM
|
Facility
|
IP
|
$8,615.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.55 |
| Max. Negotiated Rate |
$8,270.55 |
| Rate for Payer: Aetna Commercial |
$6,633.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.82
|
| Rate for Payer: Cash Price |
$4,307.58
|
| Rate for Payer: Cigna Commercial |
$7,150.58
|
| Rate for Payer: First Health Commercial |
$8,184.40
|
| Rate for Payer: Humana Commercial |
$7,322.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,357.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.46
|
| Rate for Payer: PHCS Commercial |
$8,270.55
|
| Rate for Payer: United Healthcare All Payer |
$7,581.34
|
|
|
TIBIAL COMP OSS AVL YOKE 16MM
|
Facility
|
OP
|
$8,615.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.55 |
| Max. Negotiated Rate |
$8,270.55 |
| Rate for Payer: Aetna Commercial |
$6,633.67
|
| Rate for Payer: Anthem Medicaid |
$2,962.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.82
|
| Rate for Payer: Cash Price |
$4,307.58
|
| Rate for Payer: Cigna Commercial |
$7,150.58
|
| Rate for Payer: First Health Commercial |
$8,184.40
|
| Rate for Payer: Humana Commercial |
$7,322.89
|
| Rate for Payer: Humana KY Medicaid |
$2,962.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,357.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.46
|
| Rate for Payer: PHCS Commercial |
$8,270.55
|
| Rate for Payer: United Healthcare All Payer |
$7,581.34
|
|
|
TIBIAL COMP OSS AVL YOKE 16MM
|
Facility
|
IP
|
$8,615.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.55 |
| Max. Negotiated Rate |
$8,270.55 |
| Rate for Payer: Aetna Commercial |
$6,633.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.82
|
| Rate for Payer: Cash Price |
$4,307.58
|
| Rate for Payer: Cigna Commercial |
$7,150.58
|
| Rate for Payer: First Health Commercial |
$8,184.40
|
| Rate for Payer: Humana Commercial |
$7,322.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,357.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.46
|
| Rate for Payer: PHCS Commercial |
$8,270.55
|
| Rate for Payer: United Healthcare All Payer |
$7,581.34
|
|
|
TIBIAL COMP OSS HYBRD PLY 51MM
|
Facility
|
IP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 51MM
|
Facility
|
OP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem Medicaid |
$9,576.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Humana KY Medicaid |
$9,576.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,673.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,768.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 55MM
|
Facility
|
IP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 55MM
|
Facility
|
OP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem Medicaid |
$9,576.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Humana KY Medicaid |
$9,576.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,673.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,768.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 59MM
|
Facility
|
IP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 59MM
|
Facility
|
OP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem Medicaid |
$9,576.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Humana KY Medicaid |
$9,576.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,673.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,768.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 63MM
|
Facility
|
OP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem Medicaid |
$9,576.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Humana KY Medicaid |
$9,576.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,673.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,768.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 63MM
|
Facility
|
IP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 67MM
|
Facility
|
IP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS HYBRD PLY 67MM
|
Facility
|
OP
|
$27,846.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,353.95 |
| Max. Negotiated Rate |
$26,732.64 |
| Rate for Payer: Aetna Commercial |
$21,441.81
|
| Rate for Payer: Anthem Medicaid |
$9,576.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,720.27
|
| Rate for Payer: Cash Price |
$13,923.25
|
| Rate for Payer: Cigna Commercial |
$23,112.60
|
| Rate for Payer: First Health Commercial |
$26,454.17
|
| Rate for Payer: Humana Commercial |
$23,669.53
|
| Rate for Payer: Humana KY Medicaid |
$9,576.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,673.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,834.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,550.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,353.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,768.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,504.92
|
| Rate for Payer: Ohio Health Group HMO |
$20,884.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,277.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,214.08
|
| Rate for Payer: PHCS Commercial |
$26,732.64
|
| Rate for Payer: United Healthcare All Payer |
$24,504.92
|
|
|
TIBIAL COMP OSS MOD BASPLT 63M
|
Facility
|
OP
|
$27,306.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,191.95 |
| Max. Negotiated Rate |
$26,214.24 |
| Rate for Payer: Aetna Commercial |
$21,026.01
|
| Rate for Payer: Anthem Medicaid |
$9,390.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,299.07
|
| Rate for Payer: Cash Price |
$13,653.25
|
| Rate for Payer: Cigna Commercial |
$22,664.40
|
| Rate for Payer: First Health Commercial |
$25,941.17
|
| Rate for Payer: Humana Commercial |
$23,210.53
|
| Rate for Payer: Humana KY Medicaid |
$9,390.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9,486.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,391.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,152.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,191.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,579.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,029.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,479.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,845.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,756.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,841.49
|
| Rate for Payer: PHCS Commercial |
$26,214.24
|
| Rate for Payer: United Healthcare All Payer |
$24,029.72
|
|
|
TIBIAL COMP OSS MOD BASPLT 63M
|
Facility
|
IP
|
$27,306.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,191.95 |
| Max. Negotiated Rate |
$26,214.24 |
| Rate for Payer: Aetna Commercial |
$21,026.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,299.07
|
| Rate for Payer: Cash Price |
$13,653.25
|
| Rate for Payer: Cigna Commercial |
$22,664.40
|
| Rate for Payer: First Health Commercial |
$25,941.17
|
| Rate for Payer: Humana Commercial |
$23,210.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,391.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,152.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,191.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,029.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,479.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,845.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,756.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,841.49
|
| Rate for Payer: PHCS Commercial |
$26,214.24
|
| Rate for Payer: United Healthcare All Payer |
$24,029.72
|
|
|
TIBIAL ELEOS BASEPLATE SZ 2
|
Facility
|
OP
|
$28,977.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,693.25 |
| Max. Negotiated Rate |
$27,818.40 |
| Rate for Payer: Aetna Commercial |
$22,312.67
|
| Rate for Payer: Anthem Medicaid |
$9,965.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,602.45
|
| Rate for Payer: Cash Price |
$14,488.75
|
| Rate for Payer: Cigna Commercial |
$24,051.33
|
| Rate for Payer: First Health Commercial |
$27,528.62
|
| Rate for Payer: Humana Commercial |
$24,630.88
|
| Rate for Payer: Humana KY Medicaid |
$9,965.36
|
| Rate for Payer: Kentucky WC Medicaid |
$10,066.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,761.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,385.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,693.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,165.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,500.20
|
| Rate for Payer: Ohio Health Group HMO |
$21,733.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,210.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,994.47
|
| Rate for Payer: PHCS Commercial |
$27,818.40
|
| Rate for Payer: United Healthcare All Payer |
$25,500.20
|
|
|
TIBIAL ELEOS BASEPLATE SZ 2
|
Facility
|
IP
|
$28,977.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,693.25 |
| Max. Negotiated Rate |
$27,818.40 |
| Rate for Payer: Aetna Commercial |
$22,312.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,602.45
|
| Rate for Payer: Cash Price |
$14,488.75
|
| Rate for Payer: Cigna Commercial |
$24,051.33
|
| Rate for Payer: First Health Commercial |
$27,528.62
|
| Rate for Payer: Humana Commercial |
$24,630.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,761.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,385.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,693.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,500.20
|
| Rate for Payer: Ohio Health Group HMO |
$21,733.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,210.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,994.47
|
| Rate for Payer: PHCS Commercial |
$27,818.40
|
| Rate for Payer: United Healthcare All Payer |
$25,500.20
|
|
|
TIBIAL ELEOS BASEPLATE SZ 3
|
Facility
|
IP
|
$28,977.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,693.25 |
| Max. Negotiated Rate |
$27,818.40 |
| Rate for Payer: Aetna Commercial |
$22,312.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,602.45
|
| Rate for Payer: Cash Price |
$14,488.75
|
| Rate for Payer: Cigna Commercial |
$24,051.33
|
| Rate for Payer: First Health Commercial |
$27,528.62
|
| Rate for Payer: Humana Commercial |
$24,630.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,761.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,385.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,693.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,500.20
|
| Rate for Payer: Ohio Health Group HMO |
$21,733.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,210.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,994.47
|
| Rate for Payer: PHCS Commercial |
$27,818.40
|
| Rate for Payer: United Healthcare All Payer |
$25,500.20
|
|
|
TIBIAL ELEOS BASEPLATE SZ 3
|
Facility
|
OP
|
$28,977.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,693.25 |
| Max. Negotiated Rate |
$27,818.40 |
| Rate for Payer: Aetna Commercial |
$22,312.67
|
| Rate for Payer: Anthem Medicaid |
$9,965.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,602.45
|
| Rate for Payer: Cash Price |
$14,488.75
|
| Rate for Payer: Cigna Commercial |
$24,051.33
|
| Rate for Payer: First Health Commercial |
$27,528.62
|
| Rate for Payer: Humana Commercial |
$24,630.88
|
| Rate for Payer: Humana KY Medicaid |
$9,965.36
|
| Rate for Payer: Kentucky WC Medicaid |
$10,066.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,761.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,385.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,693.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,165.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,500.20
|
| Rate for Payer: Ohio Health Group HMO |
$21,733.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,210.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,994.47
|
| Rate for Payer: PHCS Commercial |
$27,818.40
|
| Rate for Payer: United Healthcare All Payer |
$25,500.20
|
|
|
TIBIAL ELEOS BASEPLATE SZ 4
|
Facility
|
OP
|
$28,977.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,693.25 |
| Max. Negotiated Rate |
$27,818.40 |
| Rate for Payer: Aetna Commercial |
$22,312.67
|
| Rate for Payer: Anthem Medicaid |
$9,965.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,602.45
|
| Rate for Payer: Cash Price |
$14,488.75
|
| Rate for Payer: Cigna Commercial |
$24,051.33
|
| Rate for Payer: First Health Commercial |
$27,528.62
|
| Rate for Payer: Humana Commercial |
$24,630.88
|
| Rate for Payer: Humana KY Medicaid |
$9,965.36
|
| Rate for Payer: Kentucky WC Medicaid |
$10,066.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,761.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,385.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,693.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,165.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,500.20
|
| Rate for Payer: Ohio Health Group HMO |
$21,733.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,210.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,994.47
|
| Rate for Payer: PHCS Commercial |
$27,818.40
|
| Rate for Payer: United Healthcare All Payer |
$25,500.20
|
|
|
TIBIAL ELEOS BASEPLATE SZ 4
|
Facility
|
IP
|
$28,977.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,693.25 |
| Max. Negotiated Rate |
$27,818.40 |
| Rate for Payer: Aetna Commercial |
$22,312.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,602.45
|
| Rate for Payer: Cash Price |
$14,488.75
|
| Rate for Payer: Cigna Commercial |
$24,051.33
|
| Rate for Payer: First Health Commercial |
$27,528.62
|
| Rate for Payer: Humana Commercial |
$24,630.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,761.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,385.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,693.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,500.20
|
| Rate for Payer: Ohio Health Group HMO |
$21,733.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,210.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,994.47
|
| Rate for Payer: PHCS Commercial |
$27,818.40
|
| Rate for Payer: United Healthcare All Payer |
$25,500.20
|
|
|
TIBIAL HINGE BEARING COMP
|
Facility
|
OP
|
$26,324.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,897.31 |
| Max. Negotiated Rate |
$25,271.40 |
| Rate for Payer: Aetna Commercial |
$20,269.77
|
| Rate for Payer: Anthem Medicaid |
$9,052.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,533.02
|
| Rate for Payer: Cash Price |
$13,162.19
|
| Rate for Payer: Cigna Commercial |
$21,849.24
|
| Rate for Payer: First Health Commercial |
$25,008.16
|
| Rate for Payer: Humana Commercial |
$22,375.72
|
| Rate for Payer: Humana KY Medicaid |
$9,052.95
|
| Rate for Payer: Kentucky WC Medicaid |
$9,145.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,585.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,427.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,897.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,234.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,165.45
|
| Rate for Payer: Ohio Health Group HMO |
$19,743.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,059.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,902.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,163.82
|
| Rate for Payer: PHCS Commercial |
$25,271.40
|
| Rate for Payer: United Healthcare All Payer |
$23,165.45
|
|
|
TIBIAL HINGE BEARING COMP
|
Facility
|
IP
|
$26,324.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,897.31 |
| Max. Negotiated Rate |
$25,271.40 |
| Rate for Payer: Aetna Commercial |
$20,269.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,533.02
|
| Rate for Payer: Cash Price |
$13,162.19
|
| Rate for Payer: Cigna Commercial |
$21,849.24
|
| Rate for Payer: First Health Commercial |
$25,008.16
|
| Rate for Payer: Humana Commercial |
$22,375.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,585.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,427.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,897.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,165.45
|
| Rate for Payer: Ohio Health Group HMO |
$19,743.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,059.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,902.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,163.82
|
| Rate for Payer: PHCS Commercial |
$25,271.40
|
| Rate for Payer: United Healthcare All Payer |
$23,165.45
|
|
|
TIBIAL HINGE COMP W/ROT STOP
|
Facility
|
IP
|
$18,016.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,404.80 |
| Max. Negotiated Rate |
$17,295.36 |
| Rate for Payer: Aetna Commercial |
$13,872.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,052.48
|
| Rate for Payer: Cash Price |
$9,008.00
|
| Rate for Payer: Cigna Commercial |
$14,953.28
|
| Rate for Payer: First Health Commercial |
$17,115.20
|
| Rate for Payer: Humana Commercial |
$15,313.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,404.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,854.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,512.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,673.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,431.04
|
| Rate for Payer: PHCS Commercial |
$17,295.36
|
| Rate for Payer: United Healthcare All Payer |
$15,854.08
|
|
|
TIBIAL HINGE COMP W/ROT STOP
|
Facility
|
OP
|
$18,016.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,404.80 |
| Max. Negotiated Rate |
$17,295.36 |
| Rate for Payer: Aetna Commercial |
$13,872.32
|
| Rate for Payer: Anthem Medicaid |
$6,195.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,052.48
|
| Rate for Payer: Cash Price |
$9,008.00
|
| Rate for Payer: Cigna Commercial |
$14,953.28
|
| Rate for Payer: First Health Commercial |
$17,115.20
|
| Rate for Payer: Humana Commercial |
$15,313.60
|
| Rate for Payer: Humana KY Medicaid |
$6,195.70
|
| Rate for Payer: Kentucky WC Medicaid |
$6,258.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,404.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,320.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,854.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,512.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,673.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,431.04
|
| Rate for Payer: PHCS Commercial |
$17,295.36
|
| Rate for Payer: United Healthcare All Payer |
$15,854.08
|
|
