|
STEM BIOMET POR PRI TIB 83MM
|
Facility
|
OP
|
$9,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.63 |
| Max. Negotiated Rate |
$8,784.96 |
| Rate for Payer: Aetna Commercial |
$7,046.27
|
| Rate for Payer: Anthem Medicaid |
$3,147.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,137.78
|
| Rate for Payer: Cash Price |
$4,575.50
|
| Rate for Payer: Cigna Commercial |
$7,595.33
|
| Rate for Payer: First Health Commercial |
$8,693.45
|
| Rate for Payer: Humana Commercial |
$7,778.35
|
| Rate for Payer: Humana KY Medicaid |
$3,147.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,179.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,503.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,753.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,210.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,052.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,836.81
|
| Rate for Payer: PHCS Commercial |
$8,784.96
|
| Rate for Payer: United Healthcare All Payer |
$8,052.88
|
|
|
STEM BIOMET POR PRI TIB 87MM
|
Facility
|
OP
|
$9,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.63 |
| Max. Negotiated Rate |
$8,784.96 |
| Rate for Payer: Aetna Commercial |
$7,046.27
|
| Rate for Payer: Anthem Medicaid |
$3,147.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,137.78
|
| Rate for Payer: Cash Price |
$4,575.50
|
| Rate for Payer: Cigna Commercial |
$7,595.33
|
| Rate for Payer: First Health Commercial |
$8,693.45
|
| Rate for Payer: Humana Commercial |
$7,778.35
|
| Rate for Payer: Humana KY Medicaid |
$3,147.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,179.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,503.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,753.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,210.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,052.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,836.81
|
| Rate for Payer: PHCS Commercial |
$8,784.96
|
| Rate for Payer: United Healthcare All Payer |
$8,052.88
|
|
|
STEM BIOMET POR PRI TIB 87MM
|
Facility
|
IP
|
$9,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.63 |
| Max. Negotiated Rate |
$8,784.96 |
| Rate for Payer: Aetna Commercial |
$7,046.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,137.78
|
| Rate for Payer: Cash Price |
$4,575.50
|
| Rate for Payer: Cigna Commercial |
$7,595.33
|
| Rate for Payer: First Health Commercial |
$8,693.45
|
| Rate for Payer: Humana Commercial |
$7,778.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,503.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,753.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,052.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,836.81
|
| Rate for Payer: PHCS Commercial |
$8,784.96
|
| Rate for Payer: United Healthcare All Payer |
$8,052.88
|
|
|
STEM BIOMET POR PRI TIB 91MM
|
Facility
|
IP
|
$9,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.63 |
| Max. Negotiated Rate |
$8,784.96 |
| Rate for Payer: Aetna Commercial |
$7,046.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,137.78
|
| Rate for Payer: Cash Price |
$4,575.50
|
| Rate for Payer: Cigna Commercial |
$7,595.33
|
| Rate for Payer: First Health Commercial |
$8,693.45
|
| Rate for Payer: Humana Commercial |
$7,778.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,503.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,753.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,052.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,836.81
|
| Rate for Payer: PHCS Commercial |
$8,784.96
|
| Rate for Payer: United Healthcare All Payer |
$8,052.88
|
|
|
STEM BIOMET POR PRI TIB 91MM
|
Facility
|
OP
|
$9,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.63 |
| Max. Negotiated Rate |
$8,784.96 |
| Rate for Payer: Aetna Commercial |
$7,046.27
|
| Rate for Payer: Anthem Medicaid |
$3,147.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,137.78
|
| Rate for Payer: Cash Price |
$4,575.50
|
| Rate for Payer: Cigna Commercial |
$7,595.33
|
| Rate for Payer: First Health Commercial |
$8,693.45
|
| Rate for Payer: Humana Commercial |
$7,778.35
|
| Rate for Payer: Humana KY Medicaid |
$3,147.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,179.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,503.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,753.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,210.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,052.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,836.81
|
| Rate for Payer: PHCS Commercial |
$8,784.96
|
| Rate for Payer: United Healthcare All Payer |
$8,052.88
|
|
|
STEM BMETRIC 8MM
|
Facility
|
OP
|
$23,042.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,995.55 |
| Max. Negotiated Rate |
$22,120.99 |
| Rate for Payer: Aetna Commercial |
$17,742.88
|
| Rate for Payer: Anthem Medicaid |
$7,924.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,973.31
|
| Rate for Payer: Cash Price |
$11,521.35
|
| Rate for Payer: Cigna Commercial |
$19,125.44
|
| Rate for Payer: First Health Commercial |
$21,890.56
|
| Rate for Payer: Humana Commercial |
$19,586.30
|
| Rate for Payer: Humana KY Medicaid |
$7,924.38
|
| Rate for Payer: Kentucky WC Medicaid |
$8,005.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,895.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,005.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,083.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,277.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,282.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,608.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,995.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,143.24
|
| Rate for Payer: PHCS Commercial |
$22,120.99
|
| Rate for Payer: United Healthcare All Payer |
$20,277.58
|
|
|
STEM BMETRIC 8MM
|
Facility
|
IP
|
$23,042.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,995.55 |
| Max. Negotiated Rate |
$22,120.99 |
| Rate for Payer: Aetna Commercial |
$17,742.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,973.31
|
| Rate for Payer: Cash Price |
$11,521.35
|
| Rate for Payer: Cigna Commercial |
$19,125.44
|
| Rate for Payer: First Health Commercial |
$21,890.56
|
| Rate for Payer: Humana Commercial |
$19,586.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,895.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,005.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,277.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,282.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,608.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,995.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,143.24
|
| Rate for Payer: PHCS Commercial |
$22,120.99
|
| Rate for Payer: United Healthcare All Payer |
$20,277.58
|
|
|
STEM BMT SMOOTH KNE 12*200 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 12*200 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 14*200 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 14*200 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 16*160 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 16*160 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 16*200 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 16*200 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 18*160 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 18*160 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 18*200 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 18*200 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 20*160 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 20*160 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 20*200 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 20*200 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 22*160 BOW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM BMT SMOOTH KNE 22*160 BOW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
