|
STEM BMT SPLINED KNEE 16*80
|
Facility
|
OP
|
$9,964.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.35 |
| Max. Negotiated Rate |
$9,565.65 |
| Rate for Payer: Aetna Commercial |
$7,672.45
|
| Rate for Payer: Anthem Medicaid |
$3,426.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,772.09
|
| Rate for Payer: Cash Price |
$4,982.11
|
| Rate for Payer: Cigna Commercial |
$8,270.30
|
| Rate for Payer: First Health Commercial |
$9,466.01
|
| Rate for Payer: Humana Commercial |
$8,469.59
|
| Rate for Payer: Humana KY Medicaid |
$3,426.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,461.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,170.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,353.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,989.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,495.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,768.51
|
| Rate for Payer: Ohio Health Group HMO |
$7,473.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,992.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,295.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,088.91
|
| Rate for Payer: PHCS Commercial |
$9,565.65
|
| Rate for Payer: United Healthcare All Payer |
$8,768.51
|
|
|
STEM BMT SPLINED KNEE 16*80
|
Facility
|
IP
|
$9,964.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.35 |
| Max. Negotiated Rate |
$9,565.65 |
| Rate for Payer: Aetna Commercial |
$7,672.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,772.09
|
| Rate for Payer: Cash Price |
$4,982.11
|
| Rate for Payer: Cigna Commercial |
$8,270.30
|
| Rate for Payer: First Health Commercial |
$9,466.01
|
| Rate for Payer: Humana Commercial |
$8,469.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,170.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,353.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,989.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,768.51
|
| Rate for Payer: Ohio Health Group HMO |
$7,473.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,992.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,295.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,088.91
|
| Rate for Payer: PHCS Commercial |
$9,565.65
|
| Rate for Payer: United Healthcare All Payer |
$8,768.51
|
|
|
STEM BMT SPLINED KNEE 18*120
|
Facility
|
IP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 18*120
|
Facility
|
OP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem Medicaid |
$3,669.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Humana KY Medicaid |
$3,669.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,707.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,743.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 18*160
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 18*160
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 18*200
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 18*200
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 18*80
|
Facility
|
IP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 18*80
|
Facility
|
OP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem Medicaid |
$3,669.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Humana KY Medicaid |
$3,669.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,707.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,743.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 20*120
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 20*120
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 20*160
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 20*160
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 20*200
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 20*200
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 20*80
|
Facility
|
OP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem Medicaid |
$3,669.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Humana KY Medicaid |
$3,669.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,707.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,743.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 20*80
|
Facility
|
IP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 22*120
|
Facility
|
IP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 22*120
|
Facility
|
OP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem Medicaid |
$3,669.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Humana KY Medicaid |
$3,669.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,707.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,743.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
|
STEM BMT SPLINED KNEE 22*160
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 22*160
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 22*200
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 22*200
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM BMT SPLINED KNEE 22*80
|
Facility
|
OP
|
$10,671.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.30 |
| Max. Negotiated Rate |
$10,244.68 |
| Rate for Payer: Aetna Commercial |
$8,217.09
|
| Rate for Payer: Anthem Medicaid |
$3,669.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,323.80
|
| Rate for Payer: Cash Price |
$5,335.77
|
| Rate for Payer: Cigna Commercial |
$8,857.38
|
| Rate for Payer: First Health Commercial |
$10,137.96
|
| Rate for Payer: Humana Commercial |
$9,070.81
|
| Rate for Payer: Humana KY Medicaid |
$3,669.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,707.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,750.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,875.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,201.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,743.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,003.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,134.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,308.18
|
| Rate for Payer: PHCS Commercial |
$10,244.68
|
| Rate for Payer: United Healthcare All Payer |
$9,390.96
|
|
