|
G2 NP TIBIAL BASEPLATE SZ 2 L
|
Facility
|
IP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
G2 NP TIBIAL BASEPLATE SZ 3 L
|
Facility
|
OP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem Medicaid |
$3,176.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Humana KY Medicaid |
$3,176.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,208.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,239.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
G2 NP TIBIAL BASEPLATE SZ 3 L
|
Facility
|
IP
|
$9,235.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$8,866.23 |
| Rate for Payer: Aetna Commercial |
$7,111.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,203.81
|
| Rate for Payer: Cash Price |
$4,617.83
|
| Rate for Payer: Cigna Commercial |
$7,665.60
|
| Rate for Payer: First Health Commercial |
$8,773.88
|
| Rate for Payer: Humana Commercial |
$7,850.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,573.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,815.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,770.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,127.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,926.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,372.61
|
| Rate for Payer: PHCS Commercial |
$8,866.23
|
| Rate for Payer: United Healthcare All Payer |
$8,127.38
|
|
|
G2 PAT BICONVEX 23MM
|
Facility
|
IP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT BICONVEX 23MM
|
Facility
|
OP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem Medicaid |
$1,766.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Humana KY Medicaid |
$1,766.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT BICONVEX 26MM
|
Facility
|
IP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT BICONVEX 26MM
|
Facility
|
OP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem Medicaid |
$1,766.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Humana KY Medicaid |
$1,766.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT BICONVEX 29MM
|
Facility
|
IP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT BICONVEX 29MM
|
Facility
|
OP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem Medicaid |
$1,766.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Humana KY Medicaid |
$1,766.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT BICONVEX 32MM
|
Facility
|
OP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem Medicaid |
$1,766.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Humana KY Medicaid |
$1,766.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT BICONVEX 32MM
|
Facility
|
IP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT OVAL RESURFACING 29MM
|
Facility
|
IP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 29MM
|
Facility
|
OP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem Medicaid |
$1,728.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Humana KY Medicaid |
$1,728.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 32MM
|
Facility
|
IP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 32MM
|
Facility
|
OP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem Medicaid |
$1,728.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Humana KY Medicaid |
$1,728.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 35MM
|
Facility
|
OP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem Medicaid |
$1,728.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Humana KY Medicaid |
$1,728.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 35MM
|
Facility
|
IP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 38MM
|
Facility
|
OP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem Medicaid |
$1,728.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Humana KY Medicaid |
$1,728.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 38MM
|
Facility
|
IP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 41MM
|
Facility
|
OP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem Medicaid |
$1,728.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Humana KY Medicaid |
$1,728.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT OVAL RESURFACING 41MM
|
Facility
|
IP
|
$5,024.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.48 |
| Max. Negotiated Rate |
$4,823.94 |
| Rate for Payer: Aetna Commercial |
$3,869.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.45
|
| Rate for Payer: Cash Price |
$2,512.47
|
| Rate for Payer: Cigna Commercial |
$4,170.70
|
| Rate for Payer: First Health Commercial |
$4,773.69
|
| Rate for Payer: Humana Commercial |
$4,271.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.21
|
| Rate for Payer: PHCS Commercial |
$4,823.94
|
| Rate for Payer: United Healthcare All Payer |
$4,421.95
|
|
|
G2 PAT RESURFACING 29MM
|
Facility
|
OP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem Medicaid |
$1,766.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Humana KY Medicaid |
$1,766.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT RESURFACING 29MM
|
Facility
|
IP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT RESURFACING 32MM
|
Facility
|
OP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem Medicaid |
$1,766.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Humana KY Medicaid |
$1,766.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
|
G2 PAT RESURFACING 32MM
|
Facility
|
IP
|
$5,135.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.62 |
| Max. Negotiated Rate |
$4,929.99 |
| Rate for Payer: Aetna Commercial |
$3,954.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,005.62
|
| Rate for Payer: Cash Price |
$2,567.71
|
| Rate for Payer: Cigna Commercial |
$4,262.39
|
| Rate for Payer: First Health Commercial |
$4,878.64
|
| Rate for Payer: Humana Commercial |
$4,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,789.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,851.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,108.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,467.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.43
|
| Rate for Payer: PHCS Commercial |
$4,929.99
|
| Rate for Payer: United Healthcare All Payer |
$4,519.16
|
|
