|
PATCH CARDIOVASCULAR 3CM*6CM
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PATCH SOFT TISSUE 20*30CM*2MM
|
Facility
|
OP
|
$14,018.22
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,205.47 |
| Max. Negotiated Rate |
$13,457.49 |
| Rate for Payer: Aetna Commercial |
$10,794.03
|
| Rate for Payer: Anthem Medicaid |
$4,820.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,934.21
|
| Rate for Payer: Cash Price |
$7,009.11
|
| Rate for Payer: Cigna Commercial |
$11,635.12
|
| Rate for Payer: First Health Commercial |
$13,317.31
|
| Rate for Payer: Humana Commercial |
$11,915.49
|
| Rate for Payer: Humana KY Medicaid |
$4,820.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,869.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,494.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,345.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,205.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,917.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,336.03
|
| Rate for Payer: Ohio Health Group HMO |
$10,513.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,214.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,195.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,672.57
|
| Rate for Payer: PHCS Commercial |
$13,457.49
|
| Rate for Payer: United Healthcare All Payer |
$12,336.03
|
|
|
PATCH SOFT TISSUE 20*30CM*2MM
|
Facility
|
IP
|
$14,018.22
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,205.47 |
| Max. Negotiated Rate |
$13,457.49 |
| Rate for Payer: Aetna Commercial |
$10,794.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,934.21
|
| Rate for Payer: Cash Price |
$7,009.11
|
| Rate for Payer: Cigna Commercial |
$11,635.12
|
| Rate for Payer: First Health Commercial |
$13,317.31
|
| Rate for Payer: Humana Commercial |
$11,915.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,494.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,345.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,205.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,336.03
|
| Rate for Payer: Ohio Health Group HMO |
$10,513.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,214.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,195.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,672.57
|
| Rate for Payer: PHCS Commercial |
$13,457.49
|
| Rate for Payer: United Healthcare All Payer |
$12,336.03
|
|
|
PATCH VENTRALEX HERNIA 4.3*1.7
|
Facility
|
OP
|
$3,491.56
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.47 |
| Max. Negotiated Rate |
$3,351.90 |
| Rate for Payer: Aetna Commercial |
$2,688.50
|
| Rate for Payer: Anthem Medicaid |
$1,200.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.42
|
| Rate for Payer: Cash Price |
$1,745.78
|
| Rate for Payer: Cigna Commercial |
$2,897.99
|
| Rate for Payer: First Health Commercial |
$3,316.98
|
| Rate for Payer: Humana Commercial |
$2,967.83
|
| Rate for Payer: Humana KY Medicaid |
$1,200.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,212.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,863.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,224.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.18
|
| Rate for Payer: PHCS Commercial |
$3,351.90
|
| Rate for Payer: United Healthcare All Payer |
$3,072.57
|
|
|
PATCH VENTRALEX HERNIA 4.3*1.7
|
Facility
|
IP
|
$3,491.56
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.47 |
| Max. Negotiated Rate |
$3,351.90 |
| Rate for Payer: Aetna Commercial |
$2,688.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.42
|
| Rate for Payer: Cash Price |
$1,745.78
|
| Rate for Payer: Cigna Commercial |
$2,897.99
|
| Rate for Payer: First Health Commercial |
$3,316.98
|
| Rate for Payer: Humana Commercial |
$2,967.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,863.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.18
|
| Rate for Payer: PHCS Commercial |
$3,351.90
|
| Rate for Payer: United Healthcare All Payer |
$3,072.57
|
|
|
PATCH VENTRALEX HERNIA 6.4*6.4
|
Facility
|
IP
|
$3,803.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.12 |
| Max. Negotiated Rate |
$3,651.60 |
| Rate for Payer: Aetna Commercial |
$2,928.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.93
|
| Rate for Payer: Cash Price |
$1,901.88
|
| Rate for Payer: Cigna Commercial |
$3,157.11
|
| Rate for Payer: First Health Commercial |
$3,613.56
|
| Rate for Payer: Humana Commercial |
$3,233.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.59
|
| Rate for Payer: PHCS Commercial |
$3,651.60
|
| Rate for Payer: United Healthcare All Payer |
$3,347.30
|
|
|
PATCH VENTRALEX HERNIA 6.4*6.4
|
Facility
|
OP
|
$3,803.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.12 |
| Max. Negotiated Rate |
$3,651.60 |
| Rate for Payer: Aetna Commercial |
$2,928.89
|
| Rate for Payer: Anthem Medicaid |
$1,308.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.93
|
| Rate for Payer: Cash Price |
$1,901.88
|
| Rate for Payer: Cigna Commercial |
$3,157.11
|
| Rate for Payer: First Health Commercial |
$3,613.56
|
| Rate for Payer: Humana Commercial |
$3,233.19
|
| Rate for Payer: Humana KY Medicaid |
$1,308.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.59
|
| Rate for Payer: PHCS Commercial |
$3,651.60
|
| Rate for Payer: United Healthcare All Payer |
$3,347.30
|
|
|
PATCH XENOSURE BIOLOGIC 10*16
|
Facility
|
IP
|
$5,146.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.88 |
| Max. Negotiated Rate |
$4,940.40 |
| Rate for Payer: Aetna Commercial |
$3,962.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,014.07
|
| Rate for Payer: Cash Price |
$2,573.12
|
| Rate for Payer: Cigna Commercial |
$4,271.39
|
| Rate for Payer: First Health Commercial |
$4,888.94
|
| Rate for Payer: Humana Commercial |
$4,374.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.91
|
| Rate for Payer: PHCS Commercial |
$4,940.40
|
| Rate for Payer: United Healthcare All Payer |
$4,528.70
|
|
|
PATCH XENOSURE BIOLOGIC 10*16
|
Facility
|
OP
|
$5,146.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.88 |
| Max. Negotiated Rate |
$4,940.40 |
| Rate for Payer: Aetna Commercial |
$3,962.61
|
| Rate for Payer: Anthem Medicaid |
$1,769.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,014.07
|
| Rate for Payer: Cash Price |
$2,573.12
|
| Rate for Payer: Cigna Commercial |
$4,271.39
|
| Rate for Payer: First Health Commercial |
$4,888.94
|
| Rate for Payer: Humana Commercial |
$4,374.31
|
| Rate for Payer: Humana KY Medicaid |
$1,769.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.91
|
| Rate for Payer: PHCS Commercial |
$4,940.40
|
| Rate for Payer: United Healthcare All Payer |
$4,528.70
|
|
|
PATELLA 3 1/4 PEG 28MM 8MM
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.00 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.70
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
PATELLA 3 1/4 PEG 28MM 8MM
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.00 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.70
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
PATELLA ALL POLY VE 26 MM DIA
|
Facility
|
IP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA ALL POLY VE 26 MM DIA
|
Facility
|
OP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem Medicaid |
$1,974.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Humana KY Medicaid |
$1,974.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,994.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,013.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA ALL POLY VE 29 MM DIA
|
Facility
|
IP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA ALL POLY VE 29 MM DIA
|
Facility
|
OP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem Medicaid |
$1,974.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Humana KY Medicaid |
$1,974.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,994.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,013.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA ALL POLY VE 32 MM DIA
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PATELLA ALL POLY VE 32 MM DIA
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PATELLA ALL POLY VE 35 MM DIA
|
Facility
|
IP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA ALL POLY VE 35 MM DIA
|
Facility
|
OP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem Medicaid |
$1,974.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Humana KY Medicaid |
$1,974.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,994.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,013.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA ALL POLY VE 38 MM DIA
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PATELLA ALL POLY VE 38 MM DIA
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PATELLA ALL POLY VE 41 MM DIA
|
Facility
|
OP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem Medicaid |
$1,974.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Humana KY Medicaid |
$1,974.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,994.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,013.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA ALL POLY VE 41 MM DIA
|
Facility
|
IP
|
$5,740.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.19 |
| Max. Negotiated Rate |
$5,511.00 |
| Rate for Payer: Aetna Commercial |
$4,420.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.68
|
| Rate for Payer: Cash Price |
$2,870.31
|
| Rate for Payer: Cigna Commercial |
$4,764.71
|
| Rate for Payer: First Health Commercial |
$5,453.59
|
| Rate for Payer: Humana Commercial |
$4,879.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,051.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.03
|
| Rate for Payer: PHCS Commercial |
$5,511.00
|
| Rate for Payer: United Healthcare All Payer |
$5,051.75
|
|
|
PATELLA CEMENTED 32MM 8.5MM
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PATELLA CEMENTED 32MM 8.5MM
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
