|
PATELLA ALL POLY VE 35 MM DIA
|
Facility
|
OP
|
$5,691.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$739.86 |
| Max. Negotiated Rate |
$5,463.60 |
| Rate for Payer: Aetna Commercial |
$4,382.26
|
| Rate for Payer: Anthem Medicaid |
$1,957.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,439.18
|
| Rate for Payer: Cash Price |
$2,845.62
|
| Rate for Payer: Cigna Commercial |
$4,723.74
|
| Rate for Payer: First Health Commercial |
$5,406.69
|
| Rate for Payer: Humana Commercial |
$4,837.56
|
| Rate for Payer: Humana KY Medicaid |
$1,957.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,977.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,666.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,200.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,707.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,996.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,008.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,764.29
|
| Rate for Payer: PHCS Commercial |
$5,463.60
|
| Rate for Payer: United Healthcare All Payer |
$5,008.30
|
|
|
PATELLA ALL POLY VE 35 MM DIA
|
Facility
|
IP
|
$5,691.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$739.86 |
| Max. Negotiated Rate |
$5,463.60 |
| Rate for Payer: Aetna Commercial |
$4,382.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,439.18
|
| Rate for Payer: Cash Price |
$2,845.62
|
| Rate for Payer: Cigna Commercial |
$4,723.74
|
| Rate for Payer: First Health Commercial |
$5,406.69
|
| Rate for Payer: Humana Commercial |
$4,837.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,666.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,200.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,707.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,008.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,764.29
|
| Rate for Payer: PHCS Commercial |
$5,463.60
|
| Rate for Payer: United Healthcare All Payer |
$5,008.30
|
|
|
PATELLA ALL POLY VE 38 MM DIA
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PATELLA ALL POLY VE 38 MM DIA
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PATELLA ALL POLY VE 41 MM DIA
|
Facility
|
OP
|
$5,691.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$739.86 |
| Max. Negotiated Rate |
$5,463.60 |
| Rate for Payer: Aetna Commercial |
$4,382.26
|
| Rate for Payer: Anthem Medicaid |
$1,957.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,439.18
|
| Rate for Payer: Cash Price |
$2,845.62
|
| Rate for Payer: Cigna Commercial |
$4,723.74
|
| Rate for Payer: First Health Commercial |
$5,406.69
|
| Rate for Payer: Humana Commercial |
$4,837.56
|
| Rate for Payer: Humana KY Medicaid |
$1,957.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,977.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,666.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,200.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,707.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,996.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,008.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,764.29
|
| Rate for Payer: PHCS Commercial |
$5,463.60
|
| Rate for Payer: United Healthcare All Payer |
$5,008.30
|
|
|
PATELLA ALL POLY VE 41 MM DIA
|
Facility
|
IP
|
$5,691.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$739.86 |
| Max. Negotiated Rate |
$5,463.60 |
| Rate for Payer: Aetna Commercial |
$4,382.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,439.18
|
| Rate for Payer: Cash Price |
$2,845.62
|
| Rate for Payer: Cigna Commercial |
$4,723.74
|
| Rate for Payer: First Health Commercial |
$5,406.69
|
| Rate for Payer: Humana Commercial |
$4,837.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,666.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,200.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,707.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,008.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,764.29
|
| Rate for Payer: PHCS Commercial |
$5,463.60
|
| Rate for Payer: United Healthcare All Payer |
$5,008.30
|
|
|
PATELLA CEMENTED 32MM 8.5MM
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PATELLA CEMENTED 32MM 8.5MM
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PATELLA FEMORAL JOINT SM
|
Facility
|
OP
|
$7,353.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.89 |
| Max. Negotiated Rate |
$7,058.89 |
| Rate for Payer: Aetna Commercial |
$5,661.82
|
| Rate for Payer: Anthem Medicaid |
$2,528.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,735.35
|
| Rate for Payer: Cash Price |
$3,676.50
|
| Rate for Payer: Cigna Commercial |
$6,103.00
|
| Rate for Payer: First Health Commercial |
$6,985.36
|
| Rate for Payer: Humana Commercial |
$6,250.06
|
| Rate for Payer: Humana KY Medicaid |
$2,528.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,554.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,029.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,426.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,205.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,579.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,470.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,514.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,470.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$955.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,279.43
|
| Rate for Payer: PHCS Commercial |
$7,058.89
|
| Rate for Payer: United Healthcare All Payer |
$6,470.65
|
|
|
PATELLA FEMORAL JOINT SM
|
Facility
|
IP
|
$7,353.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.89 |
| Max. Negotiated Rate |
$7,058.89 |
| Rate for Payer: Aetna Commercial |
$5,661.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,735.35
|
| Rate for Payer: Cash Price |
$3,676.50
|
| Rate for Payer: Cigna Commercial |
$6,103.00
|
| Rate for Payer: First Health Commercial |
$6,985.36
|
| Rate for Payer: Humana Commercial |
$6,250.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,029.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,426.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,205.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,470.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,514.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,470.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$955.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,279.43
|
| Rate for Payer: PHCS Commercial |
$7,058.89
|
| Rate for Payer: United Healthcare All Payer |
$6,470.65
|
|
|
PATELLA FEMORAL PROSTHESIS XSM
|
Facility
|
IP
|
$25,096.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,262.60 |
| Max. Negotiated Rate |
$24,093.04 |
| Rate for Payer: Aetna Commercial |
$19,324.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,575.60
|
| Rate for Payer: Cash Price |
$12,548.46
|
| Rate for Payer: Cigna Commercial |
$20,830.44
|
| Rate for Payer: First Health Commercial |
$23,842.07
|
| Rate for Payer: Humana Commercial |
$21,332.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,579.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,521.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,529.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,085.29
|
| Rate for Payer: Ohio Health Group HMO |
$18,822.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,019.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,262.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,780.05
|
| Rate for Payer: PHCS Commercial |
$24,093.04
|
| Rate for Payer: United Healthcare All Payer |
$22,085.29
|
|
|
PATELLA FEMORAL PROSTHESIS XSM
|
Facility
|
OP
|
$25,096.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,262.60 |
| Max. Negotiated Rate |
$24,093.04 |
| Rate for Payer: Aetna Commercial |
$19,324.63
|
| Rate for Payer: Anthem Medicaid |
$8,630.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,575.60
|
| Rate for Payer: Cash Price |
$12,548.46
|
| Rate for Payer: Cigna Commercial |
$20,830.44
|
| Rate for Payer: First Health Commercial |
$23,842.07
|
| Rate for Payer: Humana Commercial |
$21,332.38
|
| Rate for Payer: Humana KY Medicaid |
$8,630.83
|
| Rate for Payer: Kentucky WC Medicaid |
$8,718.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,579.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,521.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,529.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,804.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,085.29
|
| Rate for Payer: Ohio Health Group HMO |
$18,822.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,019.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,262.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,780.05
|
| Rate for Payer: PHCS Commercial |
$24,093.04
|
| Rate for Payer: United Healthcare All Payer |
$22,085.29
|
|
|
PATELLA NEXGEN AUG SZ M 19.5MM
|
Facility
|
IP
|
$15,913.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,068.80 |
| Max. Negotiated Rate |
$15,277.31 |
| Rate for Payer: Aetna Commercial |
$12,253.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,412.81
|
| Rate for Payer: Cash Price |
$7,956.93
|
| Rate for Payer: Cigna Commercial |
$13,208.50
|
| Rate for Payer: First Health Commercial |
$15,118.17
|
| Rate for Payer: Humana Commercial |
$13,526.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,049.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,744.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,774.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,004.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,935.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,182.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,068.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,933.30
|
| Rate for Payer: PHCS Commercial |
$15,277.31
|
| Rate for Payer: United Healthcare All Payer |
$14,004.20
|
|
|
PATELLA NEXGEN AUG SZ M 19.5MM
|
Facility
|
OP
|
$15,913.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,068.80 |
| Max. Negotiated Rate |
$15,277.31 |
| Rate for Payer: Aetna Commercial |
$12,253.67
|
| Rate for Payer: Anthem Medicaid |
$5,472.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,412.81
|
| Rate for Payer: Cash Price |
$7,956.93
|
| Rate for Payer: Cigna Commercial |
$13,208.50
|
| Rate for Payer: First Health Commercial |
$15,118.17
|
| Rate for Payer: Humana Commercial |
$13,526.78
|
| Rate for Payer: Humana KY Medicaid |
$5,472.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,528.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,049.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,744.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,774.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,582.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,004.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,935.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,182.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,068.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,933.30
|
| Rate for Payer: PHCS Commercial |
$15,277.31
|
| Rate for Payer: United Healthcare All Payer |
$14,004.20
|
|
|
PATELLA PFC OVAL DOME 32MM 3PE
|
Facility
|
IP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA PFC OVAL DOME 32MM 3PE
|
Facility
|
OP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem Medicaid |
$1,614.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Humana KY Medicaid |
$1,614.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,646.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA PFC OVAL DOME 35MM
|
Facility
|
IP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA PFC OVAL DOME 35MM
|
Facility
|
OP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem Medicaid |
$1,614.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Humana KY Medicaid |
$1,614.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,646.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA PFC OVAL DOME 38MM 3PE
|
Facility
|
OP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem Medicaid |
$1,614.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Humana KY Medicaid |
$1,614.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,646.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA PFC OVAL DOME 38MM 3PE
|
Facility
|
IP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA PFC OVAL DOME 41MM 3 P
|
Facility
|
OP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem Medicaid |
$1,614.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Humana KY Medicaid |
$1,614.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,646.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA PFC OVAL DOME 41MM 3 P
|
Facility
|
IP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
PATELLA RESURFACING GENII 45MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
PATELLA RESURFACING GENII 45MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
PATELLAR LIGAMENT WHOLE W/X QU
|
Facility
|
OP
|
$17,292.30
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.00 |
| Max. Negotiated Rate |
$16,600.61 |
| Rate for Payer: Aetna Commercial |
$13,315.07
|
| Rate for Payer: Anthem Medicaid |
$5,946.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,487.99
|
| Rate for Payer: Cash Price |
$8,646.15
|
| Rate for Payer: Cigna Commercial |
$14,352.61
|
| Rate for Payer: First Health Commercial |
$16,427.68
|
| Rate for Payer: Humana Commercial |
$14,698.46
|
| Rate for Payer: Humana KY Medicaid |
$5,946.82
|
| Rate for Payer: Kentucky WC Medicaid |
$6,007.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,179.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,761.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,066.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,217.22
|
| Rate for Payer: Ohio Health Group HMO |
$12,969.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,248.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.61
|
| Rate for Payer: PHCS Commercial |
$16,600.61
|
| Rate for Payer: United Healthcare All Payer |
$15,217.22
|
|
