|
G2 PAT BICONVEX 23MM
|
Facility
|
IP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT BICONVEX 23MM
|
Facility
|
OP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem Medicaid |
$1,762.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Humana KY Medicaid |
$1,762.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT BICONVEX 26MM
|
Facility
|
IP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT BICONVEX 26MM
|
Facility
|
OP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem Medicaid |
$1,762.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Humana KY Medicaid |
$1,762.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT BICONVEX 29MM
|
Facility
|
IP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT BICONVEX 29MM
|
Facility
|
OP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem Medicaid |
$1,762.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Humana KY Medicaid |
$1,762.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT BICONVEX 32MM
|
Facility
|
IP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT BICONVEX 32MM
|
Facility
|
OP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem Medicaid |
$1,762.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Humana KY Medicaid |
$1,762.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT OVAL RESURFACING 29MM
|
Facility
|
IP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 29MM
|
Facility
|
OP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem Medicaid |
$1,727.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Humana KY Medicaid |
$1,727.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 32MM
|
Facility
|
IP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 32MM
|
Facility
|
OP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem Medicaid |
$1,727.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Humana KY Medicaid |
$1,727.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 35MM
|
Facility
|
OP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem Medicaid |
$1,727.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Humana KY Medicaid |
$1,727.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 35MM
|
Facility
|
IP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 38MM
|
Facility
|
IP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 38MM
|
Facility
|
OP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem Medicaid |
$1,727.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Humana KY Medicaid |
$1,727.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 41MM
|
Facility
|
IP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT OVAL RESURFACING 41MM
|
Facility
|
OP
|
$5,023.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$4,822.34 |
| Rate for Payer: Aetna Commercial |
$3,867.92
|
| Rate for Payer: Anthem Medicaid |
$1,727.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.15
|
| Rate for Payer: Cash Price |
$2,511.64
|
| Rate for Payer: Cigna Commercial |
$4,169.31
|
| Rate for Payer: First Health Commercial |
$4,772.11
|
| Rate for Payer: Humana Commercial |
$4,269.78
|
| Rate for Payer: Humana KY Medicaid |
$1,727.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,420.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,767.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.21
|
| Rate for Payer: PHCS Commercial |
$4,822.34
|
| Rate for Payer: United Healthcare All Payer |
$4,420.48
|
|
|
G2 PAT RESURFACING 29MM
|
Facility
|
IP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT RESURFACING 29MM
|
Facility
|
OP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem Medicaid |
$1,762.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Humana KY Medicaid |
$1,762.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT RESURFACING 32MM
|
Facility
|
OP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem Medicaid |
$1,762.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Humana KY Medicaid |
$1,762.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT RESURFACING 32MM
|
Facility
|
IP
|
$5,126.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.43 |
| Max. Negotiated Rate |
$4,921.32 |
| Rate for Payer: Aetna Commercial |
$3,947.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.58
|
| Rate for Payer: Cash Price |
$2,563.19
|
| Rate for Payer: Cigna Commercial |
$4,254.90
|
| Rate for Payer: First Health Commercial |
$4,870.06
|
| Rate for Payer: Humana Commercial |
$4,357.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.18
|
| Rate for Payer: PHCS Commercial |
$4,921.32
|
| Rate for Payer: United Healthcare All Payer |
$4,511.21
|
|
|
G2 PAT RESURFACING 35MM
|
Facility
|
OP
|
$4,691.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.85 |
| Max. Negotiated Rate |
$4,503.48 |
| Rate for Payer: Aetna Commercial |
$3,612.16
|
| Rate for Payer: Anthem Medicaid |
$1,613.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,659.07
|
| Rate for Payer: Cash Price |
$2,345.56
|
| Rate for Payer: Cigna Commercial |
$3,893.63
|
| Rate for Payer: First Health Commercial |
$4,456.56
|
| Rate for Payer: Humana Commercial |
$3,987.45
|
| Rate for Payer: Humana KY Medicaid |
$1,613.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,629.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,846.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,462.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,407.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,645.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,128.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,518.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,454.25
|
| Rate for Payer: PHCS Commercial |
$4,503.48
|
| Rate for Payer: United Healthcare All Payer |
$4,128.19
|
|
|
G2 PAT RESURFACING 35MM
|
Facility
|
IP
|
$4,691.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.85 |
| Max. Negotiated Rate |
$4,503.48 |
| Rate for Payer: Aetna Commercial |
$3,612.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,659.07
|
| Rate for Payer: Cash Price |
$2,345.56
|
| Rate for Payer: Cigna Commercial |
$3,893.63
|
| Rate for Payer: First Health Commercial |
$4,456.56
|
| Rate for Payer: Humana Commercial |
$3,987.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,846.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,462.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,407.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,128.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,518.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,454.25
|
| Rate for Payer: PHCS Commercial |
$4,503.48
|
| Rate for Payer: United Healthcare All Payer |
$4,128.19
|
|
|
G2 POST ART INSERT SZ 7-8 15MM
|
Facility
|
OP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem Medicaid |
$1,642.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Humana KY Medicaid |
$1,642.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
