|
TIBIAL PROXOSS 1 PC 7CM 9*150
|
Facility
|
OP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem Medicaid |
$28,009.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Humana KY Medicaid |
$28,009.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,294.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,571.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIBIAL PROXOSS 1 PC 7CM 9*150
|
Facility
|
IP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIBIAL ROT PROX SM COMP
|
Facility
|
IP
|
$15,985.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,795.63 |
| Max. Negotiated Rate |
$15,346.02 |
| Rate for Payer: Aetna Commercial |
$12,308.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,468.64
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cigna Commercial |
$13,267.92
|
| Rate for Payer: First Health Commercial |
$15,186.17
|
| Rate for Payer: Humana Commercial |
$13,587.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,108.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,797.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,795.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,067.19
|
| Rate for Payer: Ohio Health Group HMO |
$11,989.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,788.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,907.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,029.95
|
| Rate for Payer: PHCS Commercial |
$15,346.02
|
| Rate for Payer: United Healthcare All Payer |
$14,067.19
|
|
|
TIBIAL ROT PROX SM COMP
|
Facility
|
OP
|
$15,985.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,795.63 |
| Max. Negotiated Rate |
$15,346.02 |
| Rate for Payer: Aetna Commercial |
$12,308.79
|
| Rate for Payer: Anthem Medicaid |
$5,497.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,468.64
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cigna Commercial |
$13,267.92
|
| Rate for Payer: First Health Commercial |
$15,186.17
|
| Rate for Payer: Humana Commercial |
$13,587.62
|
| Rate for Payer: Humana KY Medicaid |
$5,497.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5,553.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,108.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,797.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,795.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,607.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,067.19
|
| Rate for Payer: Ohio Health Group HMO |
$11,989.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,788.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,907.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,029.95
|
| Rate for Payer: PHCS Commercial |
$15,346.02
|
| Rate for Payer: United Healthcare All Payer |
$14,067.19
|
|
|
TIBIAL SLEEVE OSS PROX 3CM
|
Facility
|
IP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
TIBIAL SLEEVE OSS PROX 3CM
|
Facility
|
OP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem Medicaid |
$6,093.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Humana KY Medicaid |
$6,093.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,155.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,216.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
TIBIAL SLEEVE OSS PROX 5CM
|
Facility
|
OP
|
$25,214.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,564.20 |
| Max. Negotiated Rate |
$24,205.44 |
| Rate for Payer: Aetna Commercial |
$19,414.78
|
| Rate for Payer: Anthem Medicaid |
$8,671.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,666.92
|
| Rate for Payer: Cash Price |
$12,607.00
|
| Rate for Payer: Cigna Commercial |
$20,927.62
|
| Rate for Payer: First Health Commercial |
$23,953.30
|
| Rate for Payer: Humana Commercial |
$21,431.90
|
| Rate for Payer: Humana KY Medicaid |
$8,671.09
|
| Rate for Payer: Kentucky WC Medicaid |
$8,759.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,675.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,607.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,564.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,845.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,188.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,910.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,936.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,397.66
|
| Rate for Payer: PHCS Commercial |
$24,205.44
|
| Rate for Payer: United Healthcare All Payer |
$22,188.32
|
|
|
TIBIAL SLEEVE OSS PROX 5CM
|
Facility
|
IP
|
$25,214.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,564.20 |
| Max. Negotiated Rate |
$24,205.44 |
| Rate for Payer: Aetna Commercial |
$19,414.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,666.92
|
| Rate for Payer: Cash Price |
$12,607.00
|
| Rate for Payer: Cigna Commercial |
$20,927.62
|
| Rate for Payer: First Health Commercial |
$23,953.30
|
| Rate for Payer: Humana Commercial |
$21,431.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,675.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,607.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,564.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,188.32
|
| Rate for Payer: Ohio Health Group HMO |
$18,910.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,936.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,397.66
|
| Rate for Payer: PHCS Commercial |
$24,205.44
|
| Rate for Payer: United Healthcare All Payer |
$22,188.32
|
|
|
TIBIAL SLEEVE OSS PROX 7CM
|
Facility
|
OP
|
$31,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,589.20 |
| Max. Negotiated Rate |
$30,685.44 |
| Rate for Payer: Aetna Commercial |
$24,612.28
|
| Rate for Payer: Anthem Medicaid |
$10,992.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,931.92
|
| Rate for Payer: Cash Price |
$15,982.00
|
| Rate for Payer: Cigna Commercial |
$26,530.12
|
| Rate for Payer: First Health Commercial |
$30,365.80
|
| Rate for Payer: Humana Commercial |
$27,169.40
|
| Rate for Payer: Humana KY Medicaid |
$10,992.42
|
| Rate for Payer: Kentucky WC Medicaid |
$11,104.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,210.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,589.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,589.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,212.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,128.32
|
| Rate for Payer: Ohio Health Group HMO |
$23,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,808.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,055.16
|
| Rate for Payer: PHCS Commercial |
$30,685.44
|
| Rate for Payer: United Healthcare All Payer |
$28,128.32
|
|
|
TIBIAL SLEEVE OSS PROX 7CM
|
Facility
|
IP
|
$31,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,589.20 |
| Max. Negotiated Rate |
$30,685.44 |
| Rate for Payer: Aetna Commercial |
$24,612.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,931.92
|
| Rate for Payer: Cash Price |
$15,982.00
|
| Rate for Payer: Cigna Commercial |
$26,530.12
|
| Rate for Payer: First Health Commercial |
$30,365.80
|
| Rate for Payer: Humana Commercial |
$27,169.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,210.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,589.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,589.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,128.32
|
| Rate for Payer: Ohio Health Group HMO |
$23,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,808.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,055.16
|
| Rate for Payer: PHCS Commercial |
$30,685.44
|
| Rate for Payer: United Healthcare All Payer |
$28,128.32
|
|
|
TIBIAL SLEEVE OSS PROX 9CM
|
Facility
|
OP
|
$38,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,604.75 |
| Max. Negotiated Rate |
$37,135.20 |
| Rate for Payer: Aetna Commercial |
$29,785.53
|
| Rate for Payer: Anthem Medicaid |
$13,302.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,172.35
|
| Rate for Payer: Cash Price |
$19,341.25
|
| Rate for Payer: Cigna Commercial |
$32,106.47
|
| Rate for Payer: First Health Commercial |
$36,748.38
|
| Rate for Payer: Humana Commercial |
$32,880.12
|
| Rate for Payer: Humana KY Medicaid |
$13,302.91
|
| Rate for Payer: Kentucky WC Medicaid |
$13,438.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,719.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,547.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,604.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,569.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,040.60
|
| Rate for Payer: Ohio Health Group HMO |
$29,011.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,946.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,653.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,690.92
|
| Rate for Payer: PHCS Commercial |
$37,135.20
|
| Rate for Payer: United Healthcare All Payer |
$34,040.60
|
|
|
TIBIAL SLEEVE OSS PROX 9CM
|
Facility
|
IP
|
$38,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,604.75 |
| Max. Negotiated Rate |
$37,135.20 |
| Rate for Payer: Aetna Commercial |
$29,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,172.35
|
| Rate for Payer: Cash Price |
$19,341.25
|
| Rate for Payer: Cigna Commercial |
$32,106.47
|
| Rate for Payer: First Health Commercial |
$36,748.38
|
| Rate for Payer: Humana Commercial |
$32,880.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,719.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,547.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,604.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,040.60
|
| Rate for Payer: Ohio Health Group HMO |
$29,011.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,946.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,653.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,690.92
|
| Rate for Payer: PHCS Commercial |
$37,135.20
|
| Rate for Payer: United Healthcare All Payer |
$34,040.60
|
|
|
TIBIAL SLEEVE PROX OSS RS 3CM
|
Facility
|
IP
|
$18,283.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,485.16 |
| Max. Negotiated Rate |
$17,552.52 |
| Rate for Payer: Aetna Commercial |
$14,078.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,261.43
|
| Rate for Payer: Cash Price |
$9,141.94
|
| Rate for Payer: Cigna Commercial |
$15,175.62
|
| Rate for Payer: First Health Commercial |
$17,369.69
|
| Rate for Payer: Humana Commercial |
$15,541.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,992.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,493.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,485.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,089.81
|
| Rate for Payer: Ohio Health Group HMO |
$13,712.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,627.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,906.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,615.88
|
| Rate for Payer: PHCS Commercial |
$17,552.52
|
| Rate for Payer: United Healthcare All Payer |
$16,089.81
|
|
|
TIBIAL SLEEVE PROX OSS RS 3CM
|
Facility
|
OP
|
$18,283.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,485.16 |
| Max. Negotiated Rate |
$17,552.52 |
| Rate for Payer: Aetna Commercial |
$14,078.59
|
| Rate for Payer: Anthem Medicaid |
$6,287.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,261.43
|
| Rate for Payer: Cash Price |
$9,141.94
|
| Rate for Payer: Cigna Commercial |
$15,175.62
|
| Rate for Payer: First Health Commercial |
$17,369.69
|
| Rate for Payer: Humana Commercial |
$15,541.30
|
| Rate for Payer: Humana KY Medicaid |
$6,287.83
|
| Rate for Payer: Kentucky WC Medicaid |
$6,351.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,992.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,493.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,485.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,413.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,089.81
|
| Rate for Payer: Ohio Health Group HMO |
$13,712.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,627.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,906.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,615.88
|
| Rate for Payer: PHCS Commercial |
$17,552.52
|
| Rate for Payer: United Healthcare All Payer |
$16,089.81
|
|
|
TIBIAL SLEEVE PROX OSS RS 5CM
|
Facility
|
IP
|
$26,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,827.45 |
| Max. Negotiated Rate |
$25,047.84 |
| Rate for Payer: Aetna Commercial |
$20,090.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,351.37
|
| Rate for Payer: Cash Price |
$13,045.75
|
| Rate for Payer: Cigna Commercial |
$21,655.94
|
| Rate for Payer: First Health Commercial |
$24,786.92
|
| Rate for Payer: Humana Commercial |
$22,177.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,395.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,827.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,960.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,568.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,003.13
|
| Rate for Payer: PHCS Commercial |
$25,047.84
|
| Rate for Payer: United Healthcare All Payer |
$22,960.52
|
|
|
TIBIAL SLEEVE PROX OSS RS 5CM
|
Facility
|
OP
|
$26,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,827.45 |
| Max. Negotiated Rate |
$25,047.84 |
| Rate for Payer: Aetna Commercial |
$20,090.46
|
| Rate for Payer: Anthem Medicaid |
$8,972.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,351.37
|
| Rate for Payer: Cash Price |
$13,045.75
|
| Rate for Payer: Cigna Commercial |
$21,655.94
|
| Rate for Payer: First Health Commercial |
$24,786.92
|
| Rate for Payer: Humana Commercial |
$22,177.78
|
| Rate for Payer: Humana KY Medicaid |
$8,972.87
|
| Rate for Payer: Kentucky WC Medicaid |
$9,064.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,395.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,255.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,827.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,152.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,960.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,568.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,003.13
|
| Rate for Payer: PHCS Commercial |
$25,047.84
|
| Rate for Payer: United Healthcare All Payer |
$22,960.52
|
|
|
TIBIAL SLEEVE PROX OSS RS 7CM
|
Facility
|
OP
|
$33,111.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,933.45 |
| Max. Negotiated Rate |
$31,787.04 |
| Rate for Payer: Aetna Commercial |
$25,495.85
|
| Rate for Payer: Anthem Medicaid |
$11,387.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,826.97
|
| Rate for Payer: Cash Price |
$16,555.75
|
| Rate for Payer: Cigna Commercial |
$27,482.54
|
| Rate for Payer: First Health Commercial |
$31,455.92
|
| Rate for Payer: Humana Commercial |
$28,144.78
|
| Rate for Payer: Humana KY Medicaid |
$11,387.04
|
| Rate for Payer: Kentucky WC Medicaid |
$11,502.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,151.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,436.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,933.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,615.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,138.12
|
| Rate for Payer: Ohio Health Group HMO |
$24,833.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,489.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,807.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,846.94
|
| Rate for Payer: PHCS Commercial |
$31,787.04
|
| Rate for Payer: United Healthcare All Payer |
$29,138.12
|
|
|
TIBIAL SLEEVE PROX OSS RS 7CM
|
Facility
|
IP
|
$33,111.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,933.45 |
| Max. Negotiated Rate |
$31,787.04 |
| Rate for Payer: Aetna Commercial |
$25,495.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,826.97
|
| Rate for Payer: Cash Price |
$16,555.75
|
| Rate for Payer: Cigna Commercial |
$27,482.54
|
| Rate for Payer: First Health Commercial |
$31,455.92
|
| Rate for Payer: Humana Commercial |
$28,144.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,151.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,436.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,933.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,138.12
|
| Rate for Payer: Ohio Health Group HMO |
$24,833.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,489.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,807.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,846.94
|
| Rate for Payer: PHCS Commercial |
$31,787.04
|
| Rate for Payer: United Healthcare All Payer |
$29,138.12
|
|
|
TIBIAL SLEEVE PROX OSS RS 9CM
|
Facility
|
OP
|
$38,772.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,631.75 |
| Max. Negotiated Rate |
$37,221.60 |
| Rate for Payer: Aetna Commercial |
$29,854.83
|
| Rate for Payer: Anthem Medicaid |
$13,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,242.55
|
| Rate for Payer: Cash Price |
$19,386.25
|
| Rate for Payer: Cigna Commercial |
$32,181.17
|
| Rate for Payer: First Health Commercial |
$36,833.88
|
| Rate for Payer: Humana Commercial |
$32,956.62
|
| Rate for Payer: Humana KY Medicaid |
$13,333.86
|
| Rate for Payer: Kentucky WC Medicaid |
$13,469.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,793.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,614.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,631.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,601.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,119.80
|
| Rate for Payer: Ohio Health Group HMO |
$29,079.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,018.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,732.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,753.03
|
| Rate for Payer: PHCS Commercial |
$37,221.60
|
| Rate for Payer: United Healthcare All Payer |
$34,119.80
|
|
|
TIBIAL SLEEVE PROX OSS RS 9CM
|
Facility
|
IP
|
$38,772.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,631.75 |
| Max. Negotiated Rate |
$37,221.60 |
| Rate for Payer: Aetna Commercial |
$29,854.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,242.55
|
| Rate for Payer: Cash Price |
$19,386.25
|
| Rate for Payer: Cigna Commercial |
$32,181.17
|
| Rate for Payer: First Health Commercial |
$36,833.88
|
| Rate for Payer: Humana Commercial |
$32,956.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,793.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,614.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,631.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,119.80
|
| Rate for Payer: Ohio Health Group HMO |
$29,079.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,018.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,732.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,753.03
|
| Rate for Payer: PHCS Commercial |
$37,221.60
|
| Rate for Payer: United Healthcare All Payer |
$34,119.80
|
|
|
TIBIAL STEM W/LCK BAR PLG 75MM
|
Facility
|
IP
|
$16,953.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,086.03 |
| Max. Negotiated Rate |
$16,275.29 |
| Rate for Payer: Aetna Commercial |
$13,054.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,223.68
|
| Rate for Payer: Cash Price |
$8,476.72
|
| Rate for Payer: Cigna Commercial |
$14,071.35
|
| Rate for Payer: First Health Commercial |
$16,105.76
|
| Rate for Payer: Humana Commercial |
$14,410.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,901.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,511.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,086.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,919.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,715.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,562.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,749.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,697.87
|
| Rate for Payer: PHCS Commercial |
$16,275.29
|
| Rate for Payer: United Healthcare All Payer |
$14,919.02
|
|
|
TIBIAL STEM W/LCK BAR PLG 75MM
|
Facility
|
OP
|
$16,953.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,086.03 |
| Max. Negotiated Rate |
$16,275.29 |
| Rate for Payer: Aetna Commercial |
$13,054.14
|
| Rate for Payer: Anthem Medicaid |
$5,830.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,223.68
|
| Rate for Payer: Cash Price |
$8,476.72
|
| Rate for Payer: Cigna Commercial |
$14,071.35
|
| Rate for Payer: First Health Commercial |
$16,105.76
|
| Rate for Payer: Humana Commercial |
$14,410.42
|
| Rate for Payer: Humana KY Medicaid |
$5,830.28
|
| Rate for Payer: Kentucky WC Medicaid |
$5,889.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,901.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,511.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,086.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,947.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,919.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,715.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,562.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,749.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,697.87
|
| Rate for Payer: PHCS Commercial |
$16,275.29
|
| Rate for Payer: United Healthcare All Payer |
$14,919.02
|
|
|
TIBIAL SYMMETRIC CONE AUGMENT
|
Facility
|
IP
|
$24,524.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,357.21 |
| Max. Negotiated Rate |
$23,543.08 |
| Rate for Payer: Aetna Commercial |
$18,883.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,128.75
|
| Rate for Payer: Cash Price |
$12,262.02
|
| Rate for Payer: Cigna Commercial |
$20,354.95
|
| Rate for Payer: First Health Commercial |
$23,297.84
|
| Rate for Payer: Humana Commercial |
$20,845.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,109.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,098.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,357.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,581.16
|
| Rate for Payer: Ohio Health Group HMO |
$18,393.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,619.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,335.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,921.59
|
| Rate for Payer: PHCS Commercial |
$23,543.08
|
| Rate for Payer: United Healthcare All Payer |
$21,581.16
|
|
|
TIBIAL SYMMETRIC CONE AUGMENT
|
Facility
|
OP
|
$24,524.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,357.21 |
| Max. Negotiated Rate |
$23,543.08 |
| Rate for Payer: Aetna Commercial |
$18,883.51
|
| Rate for Payer: Anthem Medicaid |
$8,433.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,128.75
|
| Rate for Payer: Cash Price |
$12,262.02
|
| Rate for Payer: Cigna Commercial |
$20,354.95
|
| Rate for Payer: First Health Commercial |
$23,297.84
|
| Rate for Payer: Humana Commercial |
$20,845.43
|
| Rate for Payer: Humana KY Medicaid |
$8,433.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,519.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,109.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,098.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,357.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,603.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,581.16
|
| Rate for Payer: Ohio Health Group HMO |
$18,393.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,619.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,335.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,921.59
|
| Rate for Payer: PHCS Commercial |
$23,543.08
|
| Rate for Payer: United Healthcare All Payer |
$21,581.16
|
|
|
TIBIAL TRAY CEM MBT REV SZ 1
|
Facility
|
IP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
