|
PATELLAR LIGAMENT WHOLE W/X QU
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PATELLAR TENDON W EXTENDER
|
Facility
|
IP
|
$29,098.05
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,782.75 |
| Max. Negotiated Rate |
$27,934.13 |
| Rate for Payer: Aetna Commercial |
$22,405.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,696.48
|
| Rate for Payer: Cash Price |
$14,549.02
|
| Rate for Payer: Cigna Commercial |
$24,151.38
|
| Rate for Payer: First Health Commercial |
$27,643.15
|
| Rate for Payer: Humana Commercial |
$24,733.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,860.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,474.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,729.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,606.28
|
| Rate for Payer: Ohio Health Group HMO |
$21,823.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,819.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,782.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,020.40
|
| Rate for Payer: PHCS Commercial |
$27,934.13
|
| Rate for Payer: United Healthcare All Payer |
$25,606.28
|
|
|
PATELLAR TENDON W EXTENDER
|
Facility
|
OP
|
$29,098.05
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,782.75 |
| Max. Negotiated Rate |
$27,934.13 |
| Rate for Payer: Aetna Commercial |
$22,405.50
|
| Rate for Payer: Anthem Medicaid |
$10,006.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,696.48
|
| Rate for Payer: Cash Price |
$14,549.02
|
| Rate for Payer: Cigna Commercial |
$24,151.38
|
| Rate for Payer: First Health Commercial |
$27,643.15
|
| Rate for Payer: Humana Commercial |
$24,733.34
|
| Rate for Payer: Humana KY Medicaid |
$10,006.82
|
| Rate for Payer: Kentucky WC Medicaid |
$10,108.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,860.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,474.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,729.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,207.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,606.28
|
| Rate for Payer: Ohio Health Group HMO |
$21,823.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,819.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,782.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,020.40
|
| Rate for Payer: PHCS Commercial |
$27,934.13
|
| Rate for Payer: United Healthcare All Payer |
$25,606.28
|
|
|
PATELLA TRIT METAL BCK A29*9
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK A29*9
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK A32*10
|
Facility
|
OP
|
$4,930.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.02 |
| Max. Negotiated Rate |
$4,733.67 |
| Rate for Payer: Aetna Commercial |
$3,796.80
|
| Rate for Payer: Anthem Medicaid |
$1,695.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,846.11
|
| Rate for Payer: Cash Price |
$2,465.46
|
| Rate for Payer: Cigna Commercial |
$4,092.66
|
| Rate for Payer: First Health Commercial |
$4,684.36
|
| Rate for Payer: Humana Commercial |
$4,191.27
|
| Rate for Payer: Humana KY Medicaid |
$1,695.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,713.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,043.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,639.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,339.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.58
|
| Rate for Payer: PHCS Commercial |
$4,733.67
|
| Rate for Payer: United Healthcare All Payer |
$4,339.20
|
|
|
PATELLA TRIT METAL BCK A32*10
|
Facility
|
IP
|
$4,930.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.02 |
| Max. Negotiated Rate |
$4,733.67 |
| Rate for Payer: Aetna Commercial |
$3,796.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,846.11
|
| Rate for Payer: Cash Price |
$2,465.46
|
| Rate for Payer: Cigna Commercial |
$4,092.66
|
| Rate for Payer: First Health Commercial |
$4,684.36
|
| Rate for Payer: Humana Commercial |
$4,191.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,043.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,639.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,339.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.58
|
| Rate for Payer: PHCS Commercial |
$4,733.67
|
| Rate for Payer: United Healthcare All Payer |
$4,339.20
|
|
|
PATELLA TRIT METAL BCK A35*10
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PATELLA TRIT METAL BCK A35*10
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PATELLA TRIT METAL BCK A38*11
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PATELLA TRIT METAL BCK A38*11
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PATELLA TRIT METAL BCK A40*11
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PATELLA TRIT METAL BCK A40*11
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PATELLA TRIT METAL BCK S31*9
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK S31*9
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK S33*9
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK S33*9
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK S36*10
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK S36*10
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK S39*11
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA TRIT METAL BCK S39*11
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PATELLA VANGUARD 3 1/4 PEGS
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.64 |
| Max. Negotiated Rate |
$3,482.88 |
| Rate for Payer: Aetna Commercial |
$2,793.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.84
|
| Rate for Payer: Cash Price |
$1,814.00
|
| Rate for Payer: Cigna Commercial |
$3,011.24
|
| Rate for Payer: First Health Commercial |
$3,446.60
|
| Rate for Payer: Humana Commercial |
$3,083.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,721.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.68
|
| Rate for Payer: PHCS Commercial |
$3,482.88
|
| Rate for Payer: United Healthcare All Payer |
$3,192.64
|
|
|
PATELLA VANGUARD 3 1/4 PEGS
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.64 |
| Max. Negotiated Rate |
$3,482.88 |
| Rate for Payer: Aetna Commercial |
$2,793.56
|
| Rate for Payer: Anthem Medicaid |
$1,247.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.84
|
| Rate for Payer: Cash Price |
$1,814.00
|
| Rate for Payer: Cigna Commercial |
$3,011.24
|
| Rate for Payer: First Health Commercial |
$3,446.60
|
| Rate for Payer: Humana Commercial |
$3,083.80
|
| Rate for Payer: Humana KY Medicaid |
$1,247.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,260.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,721.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.68
|
| Rate for Payer: PHCS Commercial |
$3,482.88
|
| Rate for Payer: United Healthcare All Payer |
$3,192.64
|
|
|
PATENCY CAPSULE PROCEDURE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 91299
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
PATENCY CAPSULE PROCEDURE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 91299
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
