|
TIBIAL TRAY CEM MBT REV SZ 1
|
Facility
|
OP
|
$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 Medicaid |
$11,456.88
|
| 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: Humana KY Medicaid |
$11,456.88
|
| Rate for Payer: Kentucky WC Medicaid |
$11,573.48
|
| 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: Molina Healthcare Medicaid |
$11,686.75
|
| 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
|
|
|
TIBIAL TRAY COMP NP SZ 1.5
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 1.5
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 2
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 2
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 2.5
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 2.5
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 4
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 4
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 5
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 5
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 6
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 6
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
TIBIAL TRAY COMP NP SZ 7
|
Facility
|
IP
|
$13,840.59
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,152.18 |
| Max. Negotiated Rate |
$13,286.97 |
| Rate for Payer: Aetna Commercial |
$10,657.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,795.66
|
| Rate for Payer: Cash Price |
$6,920.30
|
| Rate for Payer: Cigna Commercial |
$11,487.69
|
| Rate for Payer: First Health Commercial |
$13,148.56
|
| Rate for Payer: Humana Commercial |
$11,764.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,349.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,214.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,152.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,179.72
|
| Rate for Payer: Ohio Health Group HMO |
$10,380.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,072.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,041.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,550.01
|
| Rate for Payer: PHCS Commercial |
$13,286.97
|
| Rate for Payer: United Healthcare All Payer |
$12,179.72
|
|
|
TIBIAL TRAY COMP NP SZ 7
|
Facility
|
OP
|
$13,840.59
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,152.18 |
| Max. Negotiated Rate |
$13,286.97 |
| Rate for Payer: Aetna Commercial |
$10,657.25
|
| Rate for Payer: Anthem Medicaid |
$4,759.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,795.66
|
| Rate for Payer: Cash Price |
$6,920.30
|
| Rate for Payer: Cigna Commercial |
$11,487.69
|
| Rate for Payer: First Health Commercial |
$13,148.56
|
| Rate for Payer: Humana Commercial |
$11,764.50
|
| Rate for Payer: Humana KY Medicaid |
$4,759.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,808.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,349.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,214.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,152.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,855.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,179.72
|
| Rate for Payer: Ohio Health Group HMO |
$10,380.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,072.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,041.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,550.01
|
| Rate for Payer: PHCS Commercial |
$13,286.97
|
| Rate for Payer: United Healthcare All Payer |
$12,179.72
|
|
|
TIBIAL WEDGE LUG 10MM
|
Facility
|
OP
|
$3,035.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.78 |
| Max. Negotiated Rate |
$2,914.50 |
| Rate for Payer: Aetna Commercial |
$2,337.67
|
| Rate for Payer: Anthem Medicaid |
$1,044.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.03
|
| Rate for Payer: Cash Price |
$1,517.97
|
| Rate for Payer: Cigna Commercial |
$2,519.83
|
| Rate for Payer: First Health Commercial |
$2,884.14
|
| Rate for Payer: Humana Commercial |
$2,580.55
|
| Rate for Payer: Humana KY Medicaid |
$1,044.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.80
|
| Rate for Payer: PHCS Commercial |
$2,914.50
|
| Rate for Payer: United Healthcare All Payer |
$2,671.63
|
|
|
TIBIAL WEDGE LUG 10MM
|
Facility
|
IP
|
$3,035.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.78 |
| Max. Negotiated Rate |
$2,914.50 |
| Rate for Payer: Aetna Commercial |
$2,337.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.03
|
| Rate for Payer: Cash Price |
$1,517.97
|
| Rate for Payer: Cigna Commercial |
$2,519.83
|
| Rate for Payer: First Health Commercial |
$2,884.14
|
| Rate for Payer: Humana Commercial |
$2,580.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.80
|
| Rate for Payer: PHCS Commercial |
$2,914.50
|
| Rate for Payer: United Healthcare All Payer |
$2,671.63
|
|
|
TIBIAL WEDGE LUG 15MM
|
Facility
|
IP
|
$3,035.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.78 |
| Max. Negotiated Rate |
$2,914.50 |
| Rate for Payer: Aetna Commercial |
$2,337.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.03
|
| Rate for Payer: Cash Price |
$1,517.97
|
| Rate for Payer: Cigna Commercial |
$2,519.83
|
| Rate for Payer: First Health Commercial |
$2,884.14
|
| Rate for Payer: Humana Commercial |
$2,580.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.80
|
| Rate for Payer: PHCS Commercial |
$2,914.50
|
| Rate for Payer: United Healthcare All Payer |
$2,671.63
|
|
|
TIBIAL WEDGE LUG 15MM
|
Facility
|
OP
|
$3,035.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.78 |
| Max. Negotiated Rate |
$2,914.50 |
| Rate for Payer: Aetna Commercial |
$2,337.67
|
| Rate for Payer: Anthem Medicaid |
$1,044.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.03
|
| Rate for Payer: Cash Price |
$1,517.97
|
| Rate for Payer: Cigna Commercial |
$2,519.83
|
| Rate for Payer: First Health Commercial |
$2,884.14
|
| Rate for Payer: Humana Commercial |
$2,580.55
|
| Rate for Payer: Humana KY Medicaid |
$1,044.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.80
|
| Rate for Payer: PHCS Commercial |
$2,914.50
|
| Rate for Payer: United Healthcare All Payer |
$2,671.63
|
|
|
TIBIA PSN CMT 5 DEG SZ C L
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ C L
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ C R
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ C R
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ D L
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ D L
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
