|
PATELLA FEMORAL JOINT SM
|
Facility
|
IP
|
$7,553.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.90 |
| Max. Negotiated Rate |
$7,250.89 |
| Rate for Payer: Aetna Commercial |
$5,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,891.35
|
| Rate for Payer: Cash Price |
$3,776.50
|
| Rate for Payer: Cigna Commercial |
$6,269.00
|
| Rate for Payer: First Health Commercial |
$7,175.36
|
| Rate for Payer: Humana Commercial |
$6,420.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,193.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,574.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,646.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,664.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,571.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,211.58
|
| Rate for Payer: PHCS Commercial |
$7,250.89
|
| Rate for Payer: United Healthcare All Payer |
$6,646.65
|
|
|
PATELLA FEMORAL JOINT SM
|
Facility
|
OP
|
$7,553.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.90 |
| Max. Negotiated Rate |
$7,250.89 |
| Rate for Payer: Aetna Commercial |
$5,815.82
|
| Rate for Payer: Anthem Medicaid |
$2,597.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,891.35
|
| Rate for Payer: Cash Price |
$3,776.50
|
| Rate for Payer: Cigna Commercial |
$6,269.00
|
| Rate for Payer: First Health Commercial |
$7,175.36
|
| Rate for Payer: Humana Commercial |
$6,420.06
|
| Rate for Payer: Humana KY Medicaid |
$2,597.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,623.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,193.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,574.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,649.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,646.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,664.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,571.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,211.58
|
| Rate for Payer: PHCS Commercial |
$7,250.89
|
| Rate for Payer: United Healthcare All Payer |
$6,646.65
|
|
|
PATELLA FEMORAL PROSTHESIS XSM
|
Facility
|
OP
|
$25,853.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,755.90 |
| Max. Negotiated Rate |
$24,818.88 |
| Rate for Payer: Aetna Commercial |
$19,906.81
|
| Rate for Payer: Anthem Medicaid |
$8,890.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,165.34
|
| Rate for Payer: Cash Price |
$12,926.50
|
| Rate for Payer: Cigna Commercial |
$21,457.99
|
| Rate for Payer: First Health Commercial |
$24,560.35
|
| Rate for Payer: Humana Commercial |
$21,975.05
|
| Rate for Payer: Humana KY Medicaid |
$8,890.85
|
| Rate for Payer: Kentucky WC Medicaid |
$8,981.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,199.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,079.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,755.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,069.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,750.64
|
| Rate for Payer: Ohio Health Group HMO |
$19,389.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,682.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,492.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,838.57
|
| Rate for Payer: PHCS Commercial |
$24,818.88
|
| Rate for Payer: United Healthcare All Payer |
$22,750.64
|
|
|
PATELLA FEMORAL PROSTHESIS XSM
|
Facility
|
IP
|
$25,853.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,755.90 |
| Max. Negotiated Rate |
$24,818.88 |
| Rate for Payer: Aetna Commercial |
$19,906.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,165.34
|
| Rate for Payer: Cash Price |
$12,926.50
|
| Rate for Payer: Cigna Commercial |
$21,457.99
|
| Rate for Payer: First Health Commercial |
$24,560.35
|
| Rate for Payer: Humana Commercial |
$21,975.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,199.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,079.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,755.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,750.64
|
| Rate for Payer: Ohio Health Group HMO |
$19,389.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,682.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,492.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,838.57
|
| Rate for Payer: PHCS Commercial |
$24,818.88
|
| Rate for Payer: United Healthcare All Payer |
$22,750.64
|
|
|
PATELLA NEXGEN AUG SZ M 19.5MM
|
Facility
|
OP
|
$16,439.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,931.77 |
| Max. Negotiated Rate |
$15,781.67 |
| Rate for Payer: Aetna Commercial |
$12,658.21
|
| Rate for Payer: Anthem Medicaid |
$5,653.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,822.61
|
| Rate for Payer: Cash Price |
$8,219.62
|
| Rate for Payer: Cigna Commercial |
$13,644.57
|
| Rate for Payer: First Health Commercial |
$15,617.28
|
| Rate for Payer: Humana Commercial |
$13,973.35
|
| Rate for Payer: Humana KY Medicaid |
$5,653.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,710.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,931.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,766.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,466.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,329.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,151.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,302.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,343.08
|
| Rate for Payer: PHCS Commercial |
$15,781.67
|
| Rate for Payer: United Healthcare All Payer |
$14,466.53
|
|
|
PATELLA NEXGEN AUG SZ M 19.5MM
|
Facility
|
IP
|
$16,439.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,931.77 |
| Max. Negotiated Rate |
$15,781.67 |
| Rate for Payer: Aetna Commercial |
$12,658.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,822.61
|
| Rate for Payer: Cash Price |
$8,219.62
|
| Rate for Payer: Cigna Commercial |
$13,644.57
|
| Rate for Payer: First Health Commercial |
$15,617.28
|
| Rate for Payer: Humana Commercial |
$13,973.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,931.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,466.53
|
| Rate for Payer: Ohio Health Group HMO |
$12,329.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,151.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,302.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,343.08
|
| Rate for Payer: PHCS Commercial |
$15,781.67
|
| Rate for Payer: United Healthcare All Payer |
$14,466.53
|
|
|
PATELLA PFC OVAL DOME 32MM 3PE
|
Facility
|
IP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA PFC OVAL DOME 32MM 3PE
|
Facility
|
OP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem Medicaid |
$1,607.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Humana KY Medicaid |
$1,607.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA PFC OVAL DOME 35MM
|
Facility
|
IP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA PFC OVAL DOME 35MM
|
Facility
|
OP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem Medicaid |
$1,607.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Humana KY Medicaid |
$1,607.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA PFC OVAL DOME 38MM 3PE
|
Facility
|
OP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem Medicaid |
$1,607.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Humana KY Medicaid |
$1,607.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA PFC OVAL DOME 38MM 3PE
|
Facility
|
IP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA PFC OVAL DOME 41MM 3 P
|
Facility
|
OP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem Medicaid |
$1,607.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Humana KY Medicaid |
$1,607.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA PFC OVAL DOME 41MM 3 P
|
Facility
|
IP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
PATELLA RESURFACING GENII 45MM
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
PATELLA RESURFACING GENII 45MM
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
PATELLAR LIGAMENT WHOLE W/X QU
|
Facility
|
IP
|
$17,855.97
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.79 |
| Max. Negotiated Rate |
$17,141.73 |
| Rate for Payer: Aetna Commercial |
$13,749.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,927.66
|
| Rate for Payer: Cash Price |
$8,927.99
|
| Rate for Payer: Cigna Commercial |
$14,820.46
|
| Rate for Payer: First Health Commercial |
$16,963.17
|
| Rate for Payer: Humana Commercial |
$15,177.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,641.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,177.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,713.25
|
| Rate for Payer: Ohio Health Group HMO |
$13,391.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,284.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,534.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,320.62
|
| Rate for Payer: PHCS Commercial |
$17,141.73
|
| Rate for Payer: United Healthcare All Payer |
$15,713.25
|
|
|
PATELLAR LIGAMENT WHOLE W/X QU
|
Facility
|
OP
|
$17,855.97
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.79 |
| Max. Negotiated Rate |
$17,141.73 |
| Rate for Payer: Aetna Commercial |
$13,749.10
|
| Rate for Payer: Anthem Medicaid |
$6,140.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,927.66
|
| Rate for Payer: Cash Price |
$8,927.99
|
| Rate for Payer: Cigna Commercial |
$14,820.46
|
| Rate for Payer: First Health Commercial |
$16,963.17
|
| Rate for Payer: Humana Commercial |
$15,177.57
|
| Rate for Payer: Humana KY Medicaid |
$6,140.67
|
| Rate for Payer: Kentucky WC Medicaid |
$6,203.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,641.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,177.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,713.25
|
| Rate for Payer: Ohio Health Group HMO |
$13,391.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,284.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,534.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,320.62
|
| Rate for Payer: PHCS Commercial |
$17,141.73
|
| Rate for Payer: United Healthcare All Payer |
$15,713.25
|
|
|
PATELLAR TENDON W EXTENDER
|
Facility
|
IP
|
$29,963.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,989.12 |
| Max. Negotiated Rate |
$28,765.20 |
| Rate for Payer: Aetna Commercial |
$23,072.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,371.72
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cigna Commercial |
$24,869.91
|
| Rate for Payer: First Health Commercial |
$28,465.56
|
| Rate for Payer: Humana Commercial |
$25,469.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,570.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,113.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,989.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,368.10
|
| Rate for Payer: Ohio Health Group HMO |
$22,472.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,971.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,068.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,674.99
|
| Rate for Payer: PHCS Commercial |
$28,765.20
|
| Rate for Payer: United Healthcare All Payer |
$26,368.10
|
|
|
PATELLAR TENDON W EXTENDER
|
Facility
|
OP
|
$29,963.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,989.12 |
| Max. Negotiated Rate |
$28,765.20 |
| Rate for Payer: Aetna Commercial |
$23,072.09
|
| Rate for Payer: Anthem Medicaid |
$10,304.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,371.72
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cigna Commercial |
$24,869.91
|
| Rate for Payer: First Health Commercial |
$28,465.56
|
| Rate for Payer: Humana Commercial |
$25,469.19
|
| Rate for Payer: Humana KY Medicaid |
$10,304.53
|
| Rate for Payer: Kentucky WC Medicaid |
$10,409.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,570.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,113.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,989.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,511.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,368.10
|
| Rate for Payer: Ohio Health Group HMO |
$22,472.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,971.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,068.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,674.99
|
| Rate for Payer: PHCS Commercial |
$28,765.20
|
| Rate for Payer: United Healthcare All Payer |
$26,368.10
|
|
|
PATELLA SUTUREPLATE STAR 3MM
|
Facility
|
OP
|
$14,270.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,281.16 |
| Max. Negotiated Rate |
$13,699.71 |
| Rate for Payer: Aetna Commercial |
$10,988.31
|
| Rate for Payer: Anthem Medicaid |
$4,907.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,131.01
|
| Rate for Payer: Cash Price |
$7,135.27
|
| Rate for Payer: Cigna Commercial |
$11,844.54
|
| Rate for Payer: First Health Commercial |
$13,557.00
|
| Rate for Payer: Humana Commercial |
$12,129.95
|
| Rate for Payer: Humana KY Medicaid |
$4,907.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,957.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,701.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,531.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,281.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,006.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,558.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,702.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,416.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,415.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,846.67
|
| Rate for Payer: PHCS Commercial |
$13,699.71
|
| Rate for Payer: United Healthcare All Payer |
$12,558.07
|
|
|
PATELLA SUTUREPLATE STAR 3MM
|
Facility
|
IP
|
$14,270.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,281.16 |
| Max. Negotiated Rate |
$13,699.71 |
| Rate for Payer: Aetna Commercial |
$10,988.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,131.01
|
| Rate for Payer: Cash Price |
$7,135.27
|
| Rate for Payer: Cigna Commercial |
$11,844.54
|
| Rate for Payer: First Health Commercial |
$13,557.00
|
| Rate for Payer: Humana Commercial |
$12,129.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,701.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,531.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,281.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,558.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,702.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,416.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,415.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,846.67
|
| Rate for Payer: PHCS Commercial |
$13,699.71
|
| Rate for Payer: United Healthcare All Payer |
$12,558.07
|
|
|
PATELLA TRIT METAL BCK A29*9
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PATELLA TRIT METAL BCK A29*9
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PATELLA TRIT METAL BCK A32*10
|
Facility
|
IP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
