|
STEM BMT SMOOTH KNE 22*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 22*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 SPLIND KNEE 12*160 BO
|
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 SPLIND KNEE 12*160 BO
|
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 SPLIND KNEE 12*200 BO
|
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 SPLIND KNEE 12*200 BO
|
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 SPLIND KNEE 14*160 BO
|
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 SPLIND KNEE 14*160 BO
|
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 SPLIND KNEE 14*200 BO
|
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 SPLIND KNEE 14*200 BO
|
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 SPLIND KNEE 16*160 BO
|
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 SPLIND KNEE 16*160 BO
|
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 SPLIND KNEE 16*200 BO
|
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 SPLIND KNEE 16*200 BO
|
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 SPLIND KNEE 18*160 BO
|
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 SPLIND KNEE 18*160 BO
|
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 SPLIND KNEE 18*200 BO
|
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 SPLIND KNEE 18*200 BO
|
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 SPLIND KNEE 20*160 BO
|
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 SPLIND KNEE 20*160 BO
|
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 SPLIND KNEE 20*200 BO
|
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 SPLIND KNEE 20*200 BO
|
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 SPLIND KNEE 22*160 BO
|
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 SPLIND KNEE 22*160 BO
|
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 SPLIND KNEE 22*200 BO
|
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
|
|
