|
TIBIAL INSERT 16MM PEG XSM
|
Facility
|
OP
|
$7,964.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.31 |
| Max. Negotiated Rate |
$7,645.79 |
| Rate for Payer: Aetna Commercial |
$6,132.56
|
| Rate for Payer: Anthem Medicaid |
$2,738.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,212.20
|
| Rate for Payer: Cash Price |
$3,982.18
|
| Rate for Payer: Cigna Commercial |
$6,610.42
|
| Rate for Payer: First Health Commercial |
$7,566.14
|
| Rate for Payer: Humana Commercial |
$6,769.71
|
| Rate for Payer: Humana KY Medicaid |
$2,738.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.41
|
| Rate for Payer: PHCS Commercial |
$7,645.79
|
| Rate for Payer: United Healthcare All Payer |
$7,008.64
|
|
|
TIBIAL INSERT 16MM PEG XSM
|
Facility
|
IP
|
$7,964.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.31 |
| Max. Negotiated Rate |
$7,645.79 |
| Rate for Payer: Aetna Commercial |
$6,132.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,212.20
|
| Rate for Payer: Cash Price |
$3,982.18
|
| Rate for Payer: Cigna Commercial |
$6,610.42
|
| Rate for Payer: First Health Commercial |
$7,566.14
|
| Rate for Payer: Humana Commercial |
$6,769.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.41
|
| Rate for Payer: PHCS Commercial |
$7,645.79
|
| Rate for Payer: United Healthcare All Payer |
$7,008.64
|
|
|
TIBIAL INSERT FLEX PS #11 10
|
Facility
|
IP
|
$8,083.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,425.12 |
| Max. Negotiated Rate |
$7,760.37 |
| Rate for Payer: Aetna Commercial |
$6,224.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,305.30
|
| Rate for Payer: Cash Price |
$4,041.86
|
| Rate for Payer: Cigna Commercial |
$6,709.49
|
| Rate for Payer: First Health Commercial |
$7,679.53
|
| Rate for Payer: Humana Commercial |
$6,871.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,628.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,965.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,113.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,062.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,466.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,032.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,577.77
|
| Rate for Payer: PHCS Commercial |
$7,760.37
|
| Rate for Payer: United Healthcare All Payer |
$7,113.67
|
|
|
TIBIAL INSERT FLEX PS #11 10
|
Facility
|
OP
|
$8,083.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,425.12 |
| Max. Negotiated Rate |
$7,760.37 |
| Rate for Payer: Aetna Commercial |
$6,224.46
|
| Rate for Payer: Anthem Medicaid |
$2,779.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,305.30
|
| Rate for Payer: Cash Price |
$4,041.86
|
| Rate for Payer: Cigna Commercial |
$6,709.49
|
| Rate for Payer: First Health Commercial |
$7,679.53
|
| Rate for Payer: Humana Commercial |
$6,871.16
|
| Rate for Payer: Humana KY Medicaid |
$2,779.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,628.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,965.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,835.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,113.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,062.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,466.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,032.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,577.77
|
| Rate for Payer: PHCS Commercial |
$7,760.37
|
| Rate for Payer: United Healthcare All Payer |
$7,113.67
|
|
|
TIBIAL INSERT FLEX PS #11 12
|
Facility
|
IP
|
$7,750.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.25 |
| Max. Negotiated Rate |
$7,440.81 |
| Rate for Payer: Aetna Commercial |
$5,968.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,045.66
|
| Rate for Payer: Cash Price |
$3,875.42
|
| Rate for Payer: Cigna Commercial |
$6,433.20
|
| Rate for Payer: First Health Commercial |
$7,363.30
|
| Rate for Payer: Humana Commercial |
$6,588.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,355.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,720.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,820.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,813.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,200.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,348.08
|
| Rate for Payer: PHCS Commercial |
$7,440.81
|
| Rate for Payer: United Healthcare All Payer |
$6,820.74
|
|
|
TIBIAL INSERT FLEX PS #11 12
|
Facility
|
OP
|
$7,750.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.25 |
| Max. Negotiated Rate |
$7,440.81 |
| Rate for Payer: Aetna Commercial |
$5,968.15
|
| Rate for Payer: Anthem Medicaid |
$2,665.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,045.66
|
| Rate for Payer: Cash Price |
$3,875.42
|
| Rate for Payer: Cigna Commercial |
$6,433.20
|
| Rate for Payer: First Health Commercial |
$7,363.30
|
| Rate for Payer: Humana Commercial |
$6,588.21
|
| Rate for Payer: Humana KY Medicaid |
$2,665.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,692.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,355.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,720.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,718.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,820.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,813.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,200.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,348.08
|
| Rate for Payer: PHCS Commercial |
$7,440.81
|
| Rate for Payer: United Healthcare All Payer |
$6,820.74
|
|
|
TIBIAL INSERT FLEX PS #11 15
|
Facility
|
OP
|
$7,750.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.25 |
| Max. Negotiated Rate |
$7,440.81 |
| Rate for Payer: Aetna Commercial |
$5,968.15
|
| Rate for Payer: Anthem Medicaid |
$2,665.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,045.66
|
| Rate for Payer: Cash Price |
$3,875.42
|
| Rate for Payer: Cigna Commercial |
$6,433.20
|
| Rate for Payer: First Health Commercial |
$7,363.30
|
| Rate for Payer: Humana Commercial |
$6,588.21
|
| Rate for Payer: Humana KY Medicaid |
$2,665.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,692.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,355.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,720.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,718.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,820.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,813.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,200.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,348.08
|
| Rate for Payer: PHCS Commercial |
$7,440.81
|
| Rate for Payer: United Healthcare All Payer |
$6,820.74
|
|
|
TIBIAL INSERT FLEX PS #11 15
|
Facility
|
IP
|
$7,750.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.25 |
| Max. Negotiated Rate |
$7,440.81 |
| Rate for Payer: Aetna Commercial |
$5,968.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,045.66
|
| Rate for Payer: Cash Price |
$3,875.42
|
| Rate for Payer: Cigna Commercial |
$6,433.20
|
| Rate for Payer: First Health Commercial |
$7,363.30
|
| Rate for Payer: Humana Commercial |
$6,588.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,355.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,720.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,820.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,813.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,200.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,348.08
|
| Rate for Payer: PHCS Commercial |
$7,440.81
|
| Rate for Payer: United Healthcare All Payer |
$6,820.74
|
|
|
TIBIAL INSERT FLEX PS #11 18
|
Facility
|
OP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem Medicaid |
$2,507.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Humana KY Medicaid |
$2,507.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #11 18
|
Facility
|
IP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #11 21
|
Facility
|
IP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #11 21
|
Facility
|
OP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem Medicaid |
$2,507.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Humana KY Medicaid |
$2,507.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #11 24
|
Facility
|
IP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #11 24
|
Facility
|
OP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem Medicaid |
$2,507.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Humana KY Medicaid |
$2,507.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #11 8
|
Facility
|
IP
|
$7,750.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.25 |
| Max. Negotiated Rate |
$7,440.81 |
| Rate for Payer: Aetna Commercial |
$5,968.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,045.66
|
| Rate for Payer: Cash Price |
$3,875.42
|
| Rate for Payer: Cigna Commercial |
$6,433.20
|
| Rate for Payer: First Health Commercial |
$7,363.30
|
| Rate for Payer: Humana Commercial |
$6,588.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,355.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,720.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,820.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,813.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,200.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,348.08
|
| Rate for Payer: PHCS Commercial |
$7,440.81
|
| Rate for Payer: United Healthcare All Payer |
$6,820.74
|
|
|
TIBIAL INSERT FLEX PS #11 8
|
Facility
|
OP
|
$7,750.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.25 |
| Max. Negotiated Rate |
$7,440.81 |
| Rate for Payer: Aetna Commercial |
$5,968.15
|
| Rate for Payer: Anthem Medicaid |
$2,665.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,045.66
|
| Rate for Payer: Cash Price |
$3,875.42
|
| Rate for Payer: Cigna Commercial |
$6,433.20
|
| Rate for Payer: First Health Commercial |
$7,363.30
|
| Rate for Payer: Humana Commercial |
$6,588.21
|
| Rate for Payer: Humana KY Medicaid |
$2,665.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,692.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,355.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,720.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,718.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,820.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,813.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,200.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,348.08
|
| Rate for Payer: PHCS Commercial |
$7,440.81
|
| Rate for Payer: United Healthcare All Payer |
$6,820.74
|
|
|
TIBIAL INSERT FLEX PS #3 10
|
Facility
|
OP
|
$7,958.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,387.45 |
| Max. Negotiated Rate |
$7,639.83 |
| Rate for Payer: Aetna Commercial |
$6,127.78
|
| Rate for Payer: Anthem Medicaid |
$2,736.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,207.36
|
| Rate for Payer: Cash Price |
$3,979.08
|
| Rate for Payer: Cigna Commercial |
$6,605.27
|
| Rate for Payer: First Health Commercial |
$7,560.25
|
| Rate for Payer: Humana Commercial |
$6,764.44
|
| Rate for Payer: Humana KY Medicaid |
$2,736.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,764.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,873.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,791.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,003.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,366.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,923.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,491.13
|
| Rate for Payer: PHCS Commercial |
$7,639.83
|
| Rate for Payer: United Healthcare All Payer |
$7,003.18
|
|
|
TIBIAL INSERT FLEX PS #3 10
|
Facility
|
IP
|
$7,958.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,387.45 |
| Max. Negotiated Rate |
$7,639.83 |
| Rate for Payer: Aetna Commercial |
$6,127.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,207.36
|
| Rate for Payer: Cash Price |
$3,979.08
|
| Rate for Payer: Cigna Commercial |
$6,605.27
|
| Rate for Payer: First Health Commercial |
$7,560.25
|
| Rate for Payer: Humana Commercial |
$6,764.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,873.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,003.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,366.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,923.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,491.13
|
| Rate for Payer: PHCS Commercial |
$7,639.83
|
| Rate for Payer: United Healthcare All Payer |
$7,003.18
|
|
|
TIBIAL INSERT FLEX PS #3 12
|
Facility
|
IP
|
$7,479.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.78 |
| Max. Negotiated Rate |
$7,180.11 |
| Rate for Payer: Aetna Commercial |
$5,759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,833.84
|
| Rate for Payer: Cash Price |
$3,739.64
|
| Rate for Payer: Cigna Commercial |
$6,207.80
|
| Rate for Payer: First Health Commercial |
$7,105.32
|
| Rate for Payer: Humana Commercial |
$6,357.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,133.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,519.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,581.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,609.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,983.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,506.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,160.70
|
| Rate for Payer: PHCS Commercial |
$7,180.11
|
| Rate for Payer: United Healthcare All Payer |
$6,581.77
|
|
|
TIBIAL INSERT FLEX PS #3 12
|
Facility
|
OP
|
$7,479.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.78 |
| Max. Negotiated Rate |
$7,180.11 |
| Rate for Payer: Aetna Commercial |
$5,759.05
|
| Rate for Payer: Anthem Medicaid |
$2,572.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,833.84
|
| Rate for Payer: Cash Price |
$3,739.64
|
| Rate for Payer: Cigna Commercial |
$6,207.80
|
| Rate for Payer: First Health Commercial |
$7,105.32
|
| Rate for Payer: Humana Commercial |
$6,357.39
|
| Rate for Payer: Humana KY Medicaid |
$2,572.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,133.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,519.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,623.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,581.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,609.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,983.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,506.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,160.70
|
| Rate for Payer: PHCS Commercial |
$7,180.11
|
| Rate for Payer: United Healthcare All Payer |
$6,581.77
|
|
|
TIBIAL INSERT FLEX PS #3 15
|
Facility
|
IP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #3 15
|
Facility
|
OP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem Medicaid |
$2,507.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Humana KY Medicaid |
$2,507.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #3 18
|
Facility
|
OP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem Medicaid |
$2,507.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Humana KY Medicaid |
$2,507.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #3 18
|
Facility
|
IP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
|
TIBIAL INSERT FLEX PS #3 21
|
Facility
|
IP
|
$7,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.72 |
| Max. Negotiated Rate |
$7,000.70 |
| Rate for Payer: Aetna Commercial |
$5,615.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.07
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$6,052.69
|
| Rate for Payer: First Health Commercial |
$6,927.78
|
| Rate for Payer: Humana Commercial |
$6,198.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,979.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,381.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,833.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,344.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,031.76
|
| Rate for Payer: PHCS Commercial |
$7,000.70
|
| Rate for Payer: United Healthcare All Payer |
$6,417.31
|
|
