|
TIBIAL INSERT FLEX X3 #9 8MM
|
Facility
|
OP
|
$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 Medicaid |
$3,863.17
|
| 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: Humana KY Medicaid |
$3,863.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,902.49
|
| 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: Molina Healthcare Medicaid |
$3,940.68
|
| 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
|
|
|
TIBIAL INSERT PFC SZ 2 10.0MM
|
Facility
|
IP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 2 10.0MM
|
Facility
|
OP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem Medicaid |
$2,686.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Humana KY Medicaid |
$2,686.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,713.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 2 12.5MM
|
Facility
|
OP
|
$14,358.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,307.42 |
| Max. Negotiated Rate |
$13,783.74 |
| Rate for Payer: Aetna Commercial |
$11,055.71
|
| Rate for Payer: Anthem Medicaid |
$4,937.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,199.29
|
| Rate for Payer: Cash Price |
$7,179.03
|
| Rate for Payer: Cigna Commercial |
$11,917.19
|
| Rate for Payer: First Health Commercial |
$13,640.16
|
| Rate for Payer: Humana Commercial |
$12,204.35
|
| Rate for Payer: Humana KY Medicaid |
$4,937.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,987.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,773.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,596.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,307.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,036.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,635.09
|
| Rate for Payer: Ohio Health Group HMO |
$10,768.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,486.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,491.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,907.06
|
| Rate for Payer: PHCS Commercial |
$13,783.74
|
| Rate for Payer: United Healthcare All Payer |
$12,635.09
|
|
|
TIBIAL INSERT PFC SZ 2 12.5MM
|
Facility
|
IP
|
$14,358.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,307.42 |
| Max. Negotiated Rate |
$13,783.74 |
| Rate for Payer: Aetna Commercial |
$11,055.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,199.29
|
| Rate for Payer: Cash Price |
$7,179.03
|
| Rate for Payer: Cigna Commercial |
$11,917.19
|
| Rate for Payer: First Health Commercial |
$13,640.16
|
| Rate for Payer: Humana Commercial |
$12,204.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,773.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,596.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,307.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,635.09
|
| Rate for Payer: Ohio Health Group HMO |
$10,768.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,486.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,491.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,907.06
|
| Rate for Payer: PHCS Commercial |
$13,783.74
|
| Rate for Payer: United Healthcare All Payer |
$12,635.09
|
|
|
TIBIAL INSERT PFC SZ 2 15.0MM
|
Facility
|
IP
|
$13,482.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,044.72 |
| Max. Negotiated Rate |
$12,943.10 |
| Rate for Payer: Aetna Commercial |
$10,381.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,516.27
|
| Rate for Payer: Cash Price |
$6,741.20
|
| Rate for Payer: Cigna Commercial |
$11,190.39
|
| Rate for Payer: First Health Commercial |
$12,808.28
|
| Rate for Payer: Humana Commercial |
$11,460.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,055.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,950.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,044.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,864.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,111.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,785.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,729.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,302.86
|
| Rate for Payer: PHCS Commercial |
$12,943.10
|
| Rate for Payer: United Healthcare All Payer |
$11,864.51
|
|
|
TIBIAL INSERT PFC SZ 2 15.0MM
|
Facility
|
OP
|
$13,482.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,044.72 |
| Max. Negotiated Rate |
$12,943.10 |
| Rate for Payer: Aetna Commercial |
$10,381.45
|
| Rate for Payer: Anthem Medicaid |
$4,636.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,516.27
|
| Rate for Payer: Cash Price |
$6,741.20
|
| Rate for Payer: Cigna Commercial |
$11,190.39
|
| Rate for Payer: First Health Commercial |
$12,808.28
|
| Rate for Payer: Humana Commercial |
$11,460.04
|
| Rate for Payer: Humana KY Medicaid |
$4,636.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,683.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,055.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,950.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,044.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,729.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,864.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,111.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,785.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,729.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,302.86
|
| Rate for Payer: PHCS Commercial |
$12,943.10
|
| Rate for Payer: United Healthcare All Payer |
$11,864.51
|
|
|
TIBIAL INSERT PFC SZ 2 17.5MM
|
Facility
|
IP
|
$7,538.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,261.50 |
| Max. Negotiated Rate |
$7,236.81 |
| Rate for Payer: Aetna Commercial |
$5,804.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,879.91
|
| Rate for Payer: Cash Price |
$3,769.17
|
| Rate for Payer: Cigna Commercial |
$6,256.82
|
| Rate for Payer: First Health Commercial |
$7,161.42
|
| Rate for Payer: Humana Commercial |
$6,407.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,181.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,563.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,633.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,653.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,030.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,558.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,201.45
|
| Rate for Payer: PHCS Commercial |
$7,236.81
|
| Rate for Payer: United Healthcare All Payer |
$6,633.74
|
|
|
TIBIAL INSERT PFC SZ 2 17.5MM
|
Facility
|
OP
|
$7,538.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,261.50 |
| Max. Negotiated Rate |
$7,236.81 |
| Rate for Payer: Aetna Commercial |
$5,804.52
|
| Rate for Payer: Anthem Medicaid |
$2,592.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,879.91
|
| Rate for Payer: Cash Price |
$3,769.17
|
| Rate for Payer: Cigna Commercial |
$6,256.82
|
| Rate for Payer: First Health Commercial |
$7,161.42
|
| Rate for Payer: Humana Commercial |
$6,407.59
|
| Rate for Payer: Humana KY Medicaid |
$2,592.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,618.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,181.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,563.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,644.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,633.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,653.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,030.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,558.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,201.45
|
| Rate for Payer: PHCS Commercial |
$7,236.81
|
| Rate for Payer: United Healthcare All Payer |
$6,633.74
|
|
|
TIBIAL INSERT PFC SZ 3 15.0MM
|
Facility
|
OP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem Medicaid |
$2,686.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Humana KY Medicaid |
$2,686.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,713.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 3 15.0MM
|
Facility
|
IP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 3 17.5MM
|
Facility
|
OP
|
$7,281.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.43 |
| Max. Negotiated Rate |
$6,990.19 |
| Rate for Payer: Aetna Commercial |
$5,606.72
|
| Rate for Payer: Anthem Medicaid |
$2,504.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,679.53
|
| Rate for Payer: Cash Price |
$3,640.72
|
| Rate for Payer: Cigna Commercial |
$6,043.60
|
| Rate for Payer: First Health Commercial |
$6,917.38
|
| Rate for Payer: Humana Commercial |
$6,189.23
|
| Rate for Payer: Humana KY Medicaid |
$2,504.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,529.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,970.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,373.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,554.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,407.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,461.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,825.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,334.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,024.20
|
| Rate for Payer: PHCS Commercial |
$6,990.19
|
| Rate for Payer: United Healthcare All Payer |
$6,407.68
|
|
|
TIBIAL INSERT PFC SZ 3 17.5MM
|
Facility
|
IP
|
$7,281.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.43 |
| Max. Negotiated Rate |
$6,990.19 |
| Rate for Payer: Aetna Commercial |
$5,606.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,679.53
|
| Rate for Payer: Cash Price |
$3,640.72
|
| Rate for Payer: Cigna Commercial |
$6,043.60
|
| Rate for Payer: First Health Commercial |
$6,917.38
|
| Rate for Payer: Humana Commercial |
$6,189.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,970.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,373.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,407.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,461.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,825.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,334.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,024.20
|
| Rate for Payer: PHCS Commercial |
$6,990.19
|
| Rate for Payer: United Healthcare All Payer |
$6,407.68
|
|
|
TIBIAL INSERT PFC SZ 4 10.0MM
|
Facility
|
OP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem Medicaid |
$2,686.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Humana KY Medicaid |
$2,686.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,713.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 4 10.0MM
|
Facility
|
IP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 4 12.5MM
|
Facility
|
IP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 4 12.5MM
|
Facility
|
OP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem Medicaid |
$2,686.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Humana KY Medicaid |
$2,686.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,713.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 4 15.0MM
|
Facility
|
IP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 4 15.0MM
|
Facility
|
OP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem Medicaid |
$2,686.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Humana KY Medicaid |
$2,686.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,713.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 4 17.5MM
|
Facility
|
IP
|
$7,538.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,261.50 |
| Max. Negotiated Rate |
$7,236.81 |
| Rate for Payer: Aetna Commercial |
$5,804.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,879.91
|
| Rate for Payer: Cash Price |
$3,769.17
|
| Rate for Payer: Cigna Commercial |
$6,256.82
|
| Rate for Payer: First Health Commercial |
$7,161.42
|
| Rate for Payer: Humana Commercial |
$6,407.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,181.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,563.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,633.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,653.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,030.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,558.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,201.45
|
| Rate for Payer: PHCS Commercial |
$7,236.81
|
| Rate for Payer: United Healthcare All Payer |
$6,633.74
|
|
|
TIBIAL INSERT PFC SZ 4 17.5MM
|
Facility
|
OP
|
$7,538.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,261.50 |
| Max. Negotiated Rate |
$7,236.81 |
| Rate for Payer: Aetna Commercial |
$5,804.52
|
| Rate for Payer: Anthem Medicaid |
$2,592.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,879.91
|
| Rate for Payer: Cash Price |
$3,769.17
|
| Rate for Payer: Cigna Commercial |
$6,256.82
|
| Rate for Payer: First Health Commercial |
$7,161.42
|
| Rate for Payer: Humana Commercial |
$6,407.59
|
| Rate for Payer: Humana KY Medicaid |
$2,592.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,618.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,181.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,563.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,644.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,633.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,653.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,030.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,558.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,201.45
|
| Rate for Payer: PHCS Commercial |
$7,236.81
|
| Rate for Payer: United Healthcare All Payer |
$6,633.74
|
|
|
TIBIAL INSERT PFC SZ 5 10.0MM
|
Facility
|
IP
|
$15,507.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.22 |
| Max. Negotiated Rate |
$14,887.10 |
| Rate for Payer: Aetna Commercial |
$11,940.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,095.77
|
| Rate for Payer: Cash Price |
$7,753.70
|
| Rate for Payer: Cigna Commercial |
$12,871.14
|
| Rate for Payer: First Health Commercial |
$14,732.03
|
| Rate for Payer: Humana Commercial |
$13,181.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,716.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,444.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,652.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,646.51
|
| Rate for Payer: Ohio Health Group HMO |
$11,630.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,405.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,491.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,700.11
|
| Rate for Payer: PHCS Commercial |
$14,887.10
|
| Rate for Payer: United Healthcare All Payer |
$13,646.51
|
|
|
TIBIAL INSERT PFC SZ 5 10.0MM
|
Facility
|
OP
|
$15,507.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.22 |
| Max. Negotiated Rate |
$14,887.10 |
| Rate for Payer: Aetna Commercial |
$11,940.70
|
| Rate for Payer: Anthem Medicaid |
$5,332.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,095.77
|
| Rate for Payer: Cash Price |
$7,753.70
|
| Rate for Payer: Cigna Commercial |
$12,871.14
|
| Rate for Payer: First Health Commercial |
$14,732.03
|
| Rate for Payer: Humana Commercial |
$13,181.29
|
| Rate for Payer: Humana KY Medicaid |
$5,332.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,387.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,716.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,444.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,652.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,440.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,646.51
|
| Rate for Payer: Ohio Health Group HMO |
$11,630.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,405.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,491.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,700.11
|
| Rate for Payer: PHCS Commercial |
$14,887.10
|
| Rate for Payer: United Healthcare All Payer |
$13,646.51
|
|
|
TIBIAL INSERT PFC SZ 5 12.5MM
|
Facility
|
OP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem Medicaid |
$2,686.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Humana KY Medicaid |
$2,686.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,713.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
|
TIBIAL INSERT PFC SZ 5 12.5MM
|
Facility
|
IP
|
$7,810.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,343.19 |
| Max. Negotiated Rate |
$7,498.20 |
| Rate for Payer: Aetna Commercial |
$6,014.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,092.29
|
| Rate for Payer: Cash Price |
$3,905.31
|
| Rate for Payer: Cigna Commercial |
$6,482.82
|
| Rate for Payer: First Health Commercial |
$7,420.10
|
| Rate for Payer: Humana Commercial |
$6,639.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,404.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,764.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,343.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,873.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,857.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,795.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,389.33
|
| Rate for Payer: PHCS Commercial |
$7,498.20
|
| Rate for Payer: United Healthcare All Payer |
$6,873.35
|
|
