|
TIBIAL INSERT FLEX PS #7 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 #7 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 #7 21
|
Facility
|
IP
|
$8,305.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.69 |
| Max. Negotiated Rate |
$7,973.41 |
| Rate for Payer: Aetna Commercial |
$6,395.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,478.40
|
| Rate for Payer: Cash Price |
$4,152.82
|
| Rate for Payer: Cigna Commercial |
$6,893.68
|
| Rate for Payer: First Health Commercial |
$7,890.36
|
| Rate for Payer: Humana Commercial |
$7,059.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,810.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,129.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,308.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,229.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,644.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,225.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,730.89
|
| Rate for Payer: PHCS Commercial |
$7,973.41
|
| Rate for Payer: United Healthcare All Payer |
$7,308.96
|
|
|
TIBIAL INSERT FLEX PS #7 21
|
Facility
|
OP
|
$8,305.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.69 |
| Max. Negotiated Rate |
$7,973.41 |
| Rate for Payer: Aetna Commercial |
$6,395.34
|
| Rate for Payer: Anthem Medicaid |
$2,856.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,478.40
|
| Rate for Payer: Cash Price |
$4,152.82
|
| Rate for Payer: Cigna Commercial |
$6,893.68
|
| Rate for Payer: First Health Commercial |
$7,890.36
|
| Rate for Payer: Humana Commercial |
$7,059.79
|
| Rate for Payer: Humana KY Medicaid |
$2,856.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,810.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,129.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,913.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,308.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,229.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,644.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,225.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,730.89
|
| Rate for Payer: PHCS Commercial |
$7,973.41
|
| Rate for Payer: United Healthcare All Payer |
$7,308.96
|
|
|
TIBIAL INSERT FLEX PS #7 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 #7 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 #7 8
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TIBIAL INSERT FLEX PS #7 8
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TIBIAL INSERT FLEX PS #9 10
|
Facility
|
IP
|
$6,729.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.82 |
| Max. Negotiated Rate |
$6,460.21 |
| Rate for Payer: Aetna Commercial |
$5,181.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,248.92
|
| Rate for Payer: Cash Price |
$3,364.69
|
| Rate for Payer: Cigna Commercial |
$5,585.39
|
| Rate for Payer: First Health Commercial |
$6,392.92
|
| Rate for Payer: Humana Commercial |
$5,719.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.28
|
| Rate for Payer: PHCS Commercial |
$6,460.21
|
| Rate for Payer: United Healthcare All Payer |
$5,921.86
|
|
|
TIBIAL INSERT FLEX PS #9 10
|
Facility
|
OP
|
$6,729.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.82 |
| Max. Negotiated Rate |
$6,460.21 |
| Rate for Payer: Aetna Commercial |
$5,181.63
|
| Rate for Payer: Anthem Medicaid |
$2,314.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,248.92
|
| Rate for Payer: Cash Price |
$3,364.69
|
| Rate for Payer: Cigna Commercial |
$5,585.39
|
| Rate for Payer: First Health Commercial |
$6,392.92
|
| Rate for Payer: Humana Commercial |
$5,719.98
|
| Rate for Payer: Humana KY Medicaid |
$2,314.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,337.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,360.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.28
|
| Rate for Payer: PHCS Commercial |
$6,460.21
|
| Rate for Payer: United Healthcare All Payer |
$5,921.86
|
|
|
TIBIAL INSERT FLEX PS #9 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 #9 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 #9 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 #9 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 #9 18
|
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 #9 18
|
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 #9 21
|
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 #9 21
|
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 #9 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 #9 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 #9 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 #9 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 X3 #7 8MM
|
Facility
|
OP
|
$16,798.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.61 |
| Max. Negotiated Rate |
$16,126.75 |
| Rate for Payer: Aetna Commercial |
$12,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,102.99
|
| Rate for Payer: Cash Price |
$8,399.35
|
| Rate for Payer: Cigna Commercial |
$13,942.92
|
| Rate for Payer: First Health Commercial |
$15,958.76
|
| Rate for Payer: Humana Commercial |
$14,278.90
|
| Rate for Payer: Humana KY Medicaid |
$5,777.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,835.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,774.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,397.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,039.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,892.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,782.86
|
| Rate for Payer: Ohio Health Group HMO |
$12,599.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,438.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,614.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,591.10
|
| Rate for Payer: PHCS Commercial |
$16,126.75
|
| Rate for Payer: United Healthcare All Payer |
$14,782.86
|
|
|
TIBIAL INSERT FLEX X3 #7 8MM
|
Facility
|
IP
|
$16,798.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.61 |
| Max. Negotiated Rate |
$16,126.75 |
| Rate for Payer: Aetna Commercial |
$12,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,102.99
|
| Rate for Payer: Cash Price |
$8,399.35
|
| Rate for Payer: Cigna Commercial |
$13,942.92
|
| Rate for Payer: First Health Commercial |
$15,958.76
|
| Rate for Payer: Humana Commercial |
$14,278.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,774.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,397.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,039.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,782.86
|
| Rate for Payer: Ohio Health Group HMO |
$12,599.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,438.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,614.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,591.10
|
| Rate for Payer: PHCS Commercial |
$16,126.75
|
| Rate for Payer: United Healthcare All Payer |
$14,782.86
|
|
|
TIBIAL INSERT FLEX X3 #9 8MM
|
Facility
|
IP
|
$11,233.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.03 |
| Max. Negotiated Rate |
$10,784.08 |
| Rate for Payer: Aetna Commercial |
$8,649.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,762.07
|
| Rate for Payer: Cash Price |
$5,616.71
|
| Rate for Payer: Cigna Commercial |
$9,323.74
|
| Rate for Payer: First Health Commercial |
$10,671.75
|
| Rate for Payer: Humana Commercial |
$9,548.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,211.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,290.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,370.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,885.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,425.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,986.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,773.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,751.06
|
| Rate for Payer: PHCS Commercial |
$10,784.08
|
| Rate for Payer: United Healthcare All Payer |
$9,885.41
|
|
