|
TM TIBIAL CONE LARGE 51*34 R
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 55*36 L
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 55*36 L
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 55*36 R
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 55*36 R
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 60*36 L
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 60*36 L
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 60*36 R
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 60*36 R
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 67*38 L
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 67*38 L
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 67*38 R
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE LARGE 67*38 R
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 31*31
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 31*31
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 36*31
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 36*31
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 41*34
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 41*34
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 46*34
|
Facility
|
IP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TM TIBIAL CONE MEDIUM 46*34
|
Facility
|
OP
|
$22,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,768.67 |
| Max. Negotiated Rate |
$21,659.73 |
| Rate for Payer: Aetna Commercial |
$17,372.91
|
| Rate for Payer: Anthem Medicaid |
$7,759.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,598.53
|
| Rate for Payer: Cash Price |
$11,281.11
|
| Rate for Payer: Cigna Commercial |
$18,726.64
|
| Rate for Payer: First Health Commercial |
$21,434.11
|
| Rate for Payer: Humana Commercial |
$19,177.89
|
| Rate for Payer: Humana KY Medicaid |
$7,759.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,838.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,768.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,914.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,854.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,921.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,049.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,629.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,567.93
|
| Rate for Payer: PHCS Commercial |
$21,659.73
|
| Rate for Payer: United Healthcare All Payer |
$19,854.75
|
|
|
TNTMY HMSTRNG KNEE/HIPMULTTNDN
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 27391
|
| Hospital Charge Code |
76100833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
TNTMY HMSTRNG KNEE/HIPMULTTNDN
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 27391
|
| Hospital Charge Code |
76100833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
TNTMY HMSTRNG KNEE/HIPMULTTNDN
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 27391
|
| Hospital Charge Code |
761P0833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$915.28 |
| Rate for Payer: Aetna Commercial |
$831.50
|
| Rate for Payer: Ambetter Exchange |
$554.19
|
| Rate for Payer: Anthem Medicaid |
$362.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$554.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$554.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$665.03
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$915.28
|
| Rate for Payer: Healthspan PPO |
$753.16
|
| Rate for Payer: Humana Medicaid |
$362.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$708.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$554.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.23
|
| Rate for Payer: Molina Healthcare Passport |
$362.97
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$720.45
|
| Rate for Payer: UHCCP Medicaid |
$269.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$554.19
|
|
|
TNTMY HMSTRNG KNEE/HIPMULTTNDN
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 27391
|
| Hospital Charge Code |
76100833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$915.28 |
| Rate for Payer: Aetna Commercial |
$831.50
|
| Rate for Payer: Ambetter Exchange |
$554.19
|
| Rate for Payer: Anthem Medicaid |
$362.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$554.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$554.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$665.03
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$915.28
|
| Rate for Payer: Healthspan PPO |
$753.16
|
| Rate for Payer: Humana Medicaid |
$362.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$708.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$554.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.23
|
| Rate for Payer: Molina Healthcare Passport |
$362.97
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$720.45
|
| Rate for Payer: UHCCP Medicaid |
$269.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$554.19
|
|
