|
TIBIAL INSERT PFC SZ 5 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 5 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 5 17.5MM
|
Facility
|
IP
|
$4,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.20 |
| Max. Negotiated Rate |
$4,563.84 |
| Rate for Payer: Aetna Commercial |
$3,660.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,708.12
|
| Rate for Payer: Cash Price |
$2,377.00
|
| Rate for Payer: Cigna Commercial |
$3,945.82
|
| Rate for Payer: First Health Commercial |
$4,516.30
|
| Rate for Payer: Humana Commercial |
$4,040.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,898.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,508.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,426.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,183.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,565.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,803.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,135.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,280.26
|
| Rate for Payer: PHCS Commercial |
$4,563.84
|
| Rate for Payer: United Healthcare All Payer |
$4,183.52
|
|
|
TIBIAL INSERT PFC SZ 5 17.5MM
|
Facility
|
OP
|
$4,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.20 |
| Max. Negotiated Rate |
$4,563.84 |
| Rate for Payer: Aetna Commercial |
$3,660.58
|
| Rate for Payer: Anthem Medicaid |
$1,634.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,708.12
|
| Rate for Payer: Cash Price |
$2,377.00
|
| Rate for Payer: Cigna Commercial |
$3,945.82
|
| Rate for Payer: First Health Commercial |
$4,516.30
|
| Rate for Payer: Humana Commercial |
$4,040.90
|
| Rate for Payer: Humana KY Medicaid |
$1,634.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,651.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,898.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,508.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,426.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,667.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,183.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,565.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,803.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,135.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,280.26
|
| Rate for Payer: PHCS Commercial |
$4,563.84
|
| Rate for Payer: United Healthcare All Payer |
$4,183.52
|
|
|
TIBIAL INSERT PFC SZ 6 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 6 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 6 12.5MM
|
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 6 12.5MM
|
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 6 15.0MM
|
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 6 15.0MM
|
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 6 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 6 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 ROT TC3 SZ 1.5 1
|
Facility
|
IP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
TIBIAL INSERT ROT TC3 SZ 1.5 1
|
Facility
|
OP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem Medicaid |
$8,496.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Humana KY Medicaid |
$8,496.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,582.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,666.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
TIBIAL INSERT S 23MM
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem Medicaid |
$8,167.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Humana KY Medicaid |
$8,167.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,331.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
TIBIAL INSERT S 23MM
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
TIBIAL INSRT HINGE UNI SM 18MM
|
Facility
|
OP
|
$21,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,511.88 |
| Max. Negotiated Rate |
$20,838.00 |
| Rate for Payer: Aetna Commercial |
$16,713.81
|
| Rate for Payer: Anthem Medicaid |
$7,464.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,930.88
|
| Rate for Payer: Cash Price |
$10,853.12
|
| Rate for Payer: Cigna Commercial |
$18,016.19
|
| Rate for Payer: First Health Commercial |
$20,620.94
|
| Rate for Payer: Humana Commercial |
$18,450.31
|
| Rate for Payer: Humana KY Medicaid |
$7,464.78
|
| Rate for Payer: Kentucky WC Medicaid |
$7,540.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,799.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,019.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,511.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,614.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,101.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,279.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,884.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,977.31
|
| Rate for Payer: PHCS Commercial |
$20,838.00
|
| Rate for Payer: United Healthcare All Payer |
$19,101.50
|
|
|
TIBIAL INSRT HINGE UNI SM 18MM
|
Facility
|
IP
|
$21,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,511.88 |
| Max. Negotiated Rate |
$20,838.00 |
| Rate for Payer: Aetna Commercial |
$16,713.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,930.88
|
| Rate for Payer: Cash Price |
$10,853.12
|
| Rate for Payer: Cigna Commercial |
$18,016.19
|
| Rate for Payer: First Health Commercial |
$20,620.94
|
| Rate for Payer: Humana Commercial |
$18,450.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,799.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,019.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,511.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,101.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,279.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,884.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,977.31
|
| Rate for Payer: PHCS Commercial |
$20,838.00
|
| Rate for Payer: United Healthcare All Payer |
$19,101.50
|
|
|
TIBIAL INSRT PFC SZ2.5 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 INSRT PFC SZ2.5 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 INSRT PFC SZ2.5 12.5MM
|
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 INSRT PFC SZ2.5 12.5MM
|
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 INSRT PFC SZ2.5 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 INSRT PFC SZ2.5 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 JIG HEAD LEFT MD
|
Facility
|
OP
|
$11,830.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.27 |
| Max. Negotiated Rate |
$11,357.66 |
| Rate for Payer: Aetna Commercial |
$9,109.79
|
| Rate for Payer: Anthem Medicaid |
$4,068.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,228.10
|
| Rate for Payer: Cash Price |
$5,915.45
|
| Rate for Payer: Cigna Commercial |
$9,819.65
|
| Rate for Payer: First Health Commercial |
$11,239.35
|
| Rate for Payer: Humana Commercial |
$10,056.26
|
| Rate for Payer: Humana KY Medicaid |
$4,068.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,110.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,701.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,731.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,549.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,150.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,411.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,873.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,464.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,292.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,163.32
|
| Rate for Payer: PHCS Commercial |
$11,357.66
|
| Rate for Payer: United Healthcare All Payer |
$10,411.19
|
|
