|
STEM BMT SPLINED KNEE 22*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 24*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 24*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 BOW COLLARED OSS 11X150
|
Facility
|
OP
|
$16,058.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.59 |
| Max. Negotiated Rate |
$15,416.06 |
| Rate for Payer: Aetna Commercial |
$12,364.97
|
| Rate for Payer: Anthem Medicaid |
$5,522.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,525.55
|
| Rate for Payer: Cash Price |
$8,029.20
|
| Rate for Payer: Cigna Commercial |
$13,328.47
|
| Rate for Payer: First Health Commercial |
$15,255.48
|
| Rate for Payer: Humana Commercial |
$13,649.64
|
| Rate for Payer: Humana KY Medicaid |
$5,522.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,578.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,167.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,131.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,043.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,211.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,087.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.10
|
| Rate for Payer: PHCS Commercial |
$15,416.06
|
| Rate for Payer: United Healthcare All Payer |
$14,131.39
|
|
|
STEM BOW COLLARED OSS 11X150
|
Facility
|
IP
|
$16,058.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.59 |
| Max. Negotiated Rate |
$15,416.06 |
| Rate for Payer: Aetna Commercial |
$12,364.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,525.55
|
| Rate for Payer: Cash Price |
$8,029.20
|
| Rate for Payer: Cigna Commercial |
$13,328.47
|
| Rate for Payer: First Health Commercial |
$15,255.48
|
| Rate for Payer: Humana Commercial |
$13,649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,167.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,131.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,043.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,211.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,087.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.10
|
| Rate for Payer: PHCS Commercial |
$15,416.06
|
| Rate for Payer: United Healthcare All Payer |
$14,131.39
|
|
|
STEM BOW COLLARED OSS 11X225
|
Facility
|
OP
|
$16,058.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.59 |
| Max. Negotiated Rate |
$15,416.06 |
| Rate for Payer: Aetna Commercial |
$12,364.97
|
| Rate for Payer: Anthem Medicaid |
$5,522.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,525.55
|
| Rate for Payer: Cash Price |
$8,029.20
|
| Rate for Payer: Cigna Commercial |
$13,328.47
|
| Rate for Payer: First Health Commercial |
$15,255.48
|
| Rate for Payer: Humana Commercial |
$13,649.64
|
| Rate for Payer: Humana KY Medicaid |
$5,522.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,578.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,167.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,131.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,043.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,211.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,087.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.10
|
| Rate for Payer: PHCS Commercial |
$15,416.06
|
| Rate for Payer: United Healthcare All Payer |
$14,131.39
|
|
|
STEM BOW COLLARED OSS 11X225
|
Facility
|
IP
|
$16,058.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.59 |
| Max. Negotiated Rate |
$15,416.06 |
| Rate for Payer: Aetna Commercial |
$12,364.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,525.55
|
| Rate for Payer: Cash Price |
$8,029.20
|
| Rate for Payer: Cigna Commercial |
$13,328.47
|
| Rate for Payer: First Health Commercial |
$15,255.48
|
| Rate for Payer: Humana Commercial |
$13,649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,167.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,131.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,043.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,211.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,087.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.10
|
| Rate for Payer: PHCS Commercial |
$15,416.06
|
| Rate for Payer: United Healthcare All Payer |
$14,131.39
|
|
|
STEM BOW COLLARED OSS 11X300
|
Facility
|
IP
|
$16,058.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.59 |
| Max. Negotiated Rate |
$15,416.06 |
| Rate for Payer: Aetna Commercial |
$12,364.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,525.55
|
| Rate for Payer: Cash Price |
$8,029.20
|
| Rate for Payer: Cigna Commercial |
$13,328.47
|
| Rate for Payer: First Health Commercial |
$15,255.48
|
| Rate for Payer: Humana Commercial |
$13,649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,167.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,131.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,043.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,211.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,087.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.10
|
| Rate for Payer: PHCS Commercial |
$15,416.06
|
| Rate for Payer: United Healthcare All Payer |
$14,131.39
|
|
|
STEM BOW COLLARED OSS 11X300
|
Facility
|
OP
|
$16,058.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.59 |
| Max. Negotiated Rate |
$15,416.06 |
| Rate for Payer: Aetna Commercial |
$12,364.97
|
| Rate for Payer: Anthem Medicaid |
$5,522.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,525.55
|
| Rate for Payer: Cash Price |
$8,029.20
|
| Rate for Payer: Cigna Commercial |
$13,328.47
|
| Rate for Payer: First Health Commercial |
$15,255.48
|
| Rate for Payer: Humana Commercial |
$13,649.64
|
| Rate for Payer: Humana KY Medicaid |
$5,522.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,578.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,167.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,131.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,043.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,211.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,087.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.10
|
| Rate for Payer: PHCS Commercial |
$15,416.06
|
| Rate for Payer: United Healthcare All Payer |
$14,131.39
|
|
|
STEM BOWD BUL TIP DIST 13*150
|
Facility
|
OP
|
$22,429.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,915.84 |
| Max. Negotiated Rate |
$21,532.32 |
| Rate for Payer: Aetna Commercial |
$17,270.72
|
| Rate for Payer: Anthem Medicaid |
$7,713.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,495.01
|
| Rate for Payer: Cash Price |
$11,214.75
|
| Rate for Payer: Cigna Commercial |
$18,616.48
|
| Rate for Payer: First Health Commercial |
$21,308.02
|
| Rate for Payer: Humana Commercial |
$19,065.08
|
| Rate for Payer: Humana KY Medicaid |
$7,713.51
|
| Rate for Payer: Kentucky WC Medicaid |
$7,792.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,392.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,552.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,728.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,868.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,737.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,822.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,485.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,915.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,953.14
|
| Rate for Payer: PHCS Commercial |
$21,532.32
|
| Rate for Payer: United Healthcare All Payer |
$19,737.96
|
|
|
STEM BOWD BUL TIP DIST 13*150
|
Facility
|
IP
|
$22,429.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,915.84 |
| Max. Negotiated Rate |
$21,532.32 |
| Rate for Payer: Aetna Commercial |
$17,270.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,495.01
|
| Rate for Payer: Cash Price |
$11,214.75
|
| Rate for Payer: Cigna Commercial |
$18,616.48
|
| Rate for Payer: First Health Commercial |
$21,308.02
|
| Rate for Payer: Humana Commercial |
$19,065.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,392.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,552.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,728.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,737.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,822.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,485.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,915.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,953.14
|
| Rate for Payer: PHCS Commercial |
$21,532.32
|
| Rate for Payer: United Healthcare All Payer |
$19,737.96
|
|
|
STEM CEMENTED OSS IM 10X90MM
|
Facility
|
OP
|
$12,892.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.99 |
| Max. Negotiated Rate |
$12,376.51 |
| Rate for Payer: Aetna Commercial |
$9,926.99
|
| Rate for Payer: Anthem Medicaid |
$4,433.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,055.92
|
| Rate for Payer: Cash Price |
$6,446.10
|
| Rate for Payer: Cigna Commercial |
$10,700.53
|
| Rate for Payer: First Health Commercial |
$12,247.59
|
| Rate for Payer: Humana Commercial |
$10,958.37
|
| Rate for Payer: Humana KY Medicaid |
$4,433.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,478.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,571.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,514.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,867.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,522.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,345.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,669.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,578.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,996.58
|
| Rate for Payer: PHCS Commercial |
$12,376.51
|
| Rate for Payer: United Healthcare All Payer |
$11,345.14
|
|
|
STEM CEMENTED OSS IM 10X90MM
|
Facility
|
IP
|
$12,892.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.99 |
| Max. Negotiated Rate |
$12,376.51 |
| Rate for Payer: Aetna Commercial |
$9,926.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,055.92
|
| Rate for Payer: Cash Price |
$6,446.10
|
| Rate for Payer: Cigna Commercial |
$10,700.53
|
| Rate for Payer: First Health Commercial |
$12,247.59
|
| Rate for Payer: Humana Commercial |
$10,958.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,571.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,514.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,867.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,345.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,669.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,578.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,996.58
|
| Rate for Payer: PHCS Commercial |
$12,376.51
|
| Rate for Payer: United Healthcare All Payer |
$11,345.14
|
|
|
STEM CEMENTED OSS IM 11X150
|
Facility
|
OP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem Medicaid |
$4,444.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Humana KY Medicaid |
$4,444.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,489.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 11X150
|
Facility
|
IP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 11X225
|
Facility
|
IP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM CEMENTED OSS IM 11X225
|
Facility
|
OP
|
$15,181.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.59 |
| Max. Negotiated Rate |
$14,574.18 |
| Rate for Payer: Aetna Commercial |
$11,689.71
|
| Rate for Payer: Anthem Medicaid |
$5,220.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,841.52
|
| Rate for Payer: Cash Price |
$7,590.72
|
| Rate for Payer: Cigna Commercial |
$12,600.60
|
| Rate for Payer: First Health Commercial |
$14,422.37
|
| Rate for Payer: Humana Commercial |
$12,904.22
|
| Rate for Payer: Humana KY Medicaid |
$5,220.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,274.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,448.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,203.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,325.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,359.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,386.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,706.25
|
| Rate for Payer: PHCS Commercial |
$14,574.18
|
| Rate for Payer: United Healthcare All Payer |
$13,359.67
|
|
|
STEM CEMENTED OSS IM 11X300MM
|
Facility
|
OP
|
$15,699.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.98 |
| Max. Negotiated Rate |
$15,071.85 |
| Rate for Payer: Aetna Commercial |
$12,088.88
|
| Rate for Payer: Anthem Medicaid |
$5,399.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.88
|
| Rate for Payer: Cash Price |
$7,849.92
|
| Rate for Payer: Cigna Commercial |
$13,030.87
|
| Rate for Payer: First Health Commercial |
$14,914.85
|
| Rate for Payer: Humana Commercial |
$13,344.86
|
| Rate for Payer: Humana KY Medicaid |
$5,399.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,454.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,507.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.95
|
| Rate for Payer: PHCS Commercial |
$15,071.85
|
| Rate for Payer: United Healthcare All Payer |
$13,815.86
|
|
|
STEM CEMENTED OSS IM 11X300MM
|
Facility
|
IP
|
$15,699.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.98 |
| Max. Negotiated Rate |
$15,071.85 |
| Rate for Payer: Aetna Commercial |
$12,088.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.88
|
| Rate for Payer: Cash Price |
$7,849.92
|
| Rate for Payer: Cigna Commercial |
$13,030.87
|
| Rate for Payer: First Health Commercial |
$14,914.85
|
| Rate for Payer: Humana Commercial |
$13,344.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.95
|
| Rate for Payer: PHCS Commercial |
$15,071.85
|
| Rate for Payer: United Healthcare All Payer |
$13,815.86
|
|
|
STEM CEMENTED OSS IM 11X90MM
|
Facility
|
IP
|
$12,143.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,578.70 |
| Max. Negotiated Rate |
$11,658.12 |
| Rate for Payer: Aetna Commercial |
$9,350.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,472.23
|
| Rate for Payer: Cash Price |
$6,071.94
|
| Rate for Payer: Cigna Commercial |
$10,079.42
|
| Rate for Payer: First Health Commercial |
$11,536.69
|
| Rate for Payer: Humana Commercial |
$10,322.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,957.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,962.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,643.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,686.61
|
| Rate for Payer: Ohio Health Group HMO |
$9,107.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,764.60
|
| Rate for Payer: PHCS Commercial |
$11,658.12
|
| Rate for Payer: United Healthcare All Payer |
$10,686.61
|
|
|
STEM CEMENTED OSS IM 11X90MM
|
Facility
|
OP
|
$12,143.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,578.70 |
| Max. Negotiated Rate |
$11,658.12 |
| Rate for Payer: Aetna Commercial |
$9,350.79
|
| Rate for Payer: Anthem Medicaid |
$4,176.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,472.23
|
| Rate for Payer: Cash Price |
$6,071.94
|
| Rate for Payer: Cigna Commercial |
$10,079.42
|
| Rate for Payer: First Health Commercial |
$11,536.69
|
| Rate for Payer: Humana Commercial |
$10,322.30
|
| Rate for Payer: Humana KY Medicaid |
$4,176.28
|
| Rate for Payer: Kentucky WC Medicaid |
$4,218.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,957.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,962.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,643.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,260.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,686.61
|
| Rate for Payer: Ohio Health Group HMO |
$9,107.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,764.60
|
| Rate for Payer: PHCS Commercial |
$11,658.12
|
| Rate for Payer: United Healthcare All Payer |
$10,686.61
|
|
|
STEM CEMENTED OSS IM 12X150
|
Facility
|
IP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 12X150
|
Facility
|
OP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem Medicaid |
$4,444.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Humana KY Medicaid |
$4,444.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,489.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 12X90MM
|
Facility
|
OP
|
$12,143.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,578.70 |
| Max. Negotiated Rate |
$11,658.12 |
| Rate for Payer: Aetna Commercial |
$9,350.79
|
| Rate for Payer: Anthem Medicaid |
$4,176.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,472.23
|
| Rate for Payer: Cash Price |
$6,071.94
|
| Rate for Payer: Cigna Commercial |
$10,079.42
|
| Rate for Payer: First Health Commercial |
$11,536.69
|
| Rate for Payer: Humana Commercial |
$10,322.30
|
| Rate for Payer: Humana KY Medicaid |
$4,176.28
|
| Rate for Payer: Kentucky WC Medicaid |
$4,218.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,957.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,962.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,643.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,260.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,686.61
|
| Rate for Payer: Ohio Health Group HMO |
$9,107.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,764.60
|
| Rate for Payer: PHCS Commercial |
$11,658.12
|
| Rate for Payer: United Healthcare All Payer |
$10,686.61
|
|
|
STEM CEMENTED OSS IM 12X90MM
|
Facility
|
IP
|
$12,143.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,578.70 |
| Max. Negotiated Rate |
$11,658.12 |
| Rate for Payer: Aetna Commercial |
$9,350.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,472.23
|
| Rate for Payer: Cash Price |
$6,071.94
|
| Rate for Payer: Cigna Commercial |
$10,079.42
|
| Rate for Payer: First Health Commercial |
$11,536.69
|
| Rate for Payer: Humana Commercial |
$10,322.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,957.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,962.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,643.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,686.61
|
| Rate for Payer: Ohio Health Group HMO |
$9,107.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,764.60
|
| Rate for Payer: PHCS Commercial |
$11,658.12
|
| Rate for Payer: United Healthcare All Payer |
$10,686.61
|
|
