|
STEM HUMERAL 5*105MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 5*105MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 6*115MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 6*115MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 7*140MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 7*140MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 8*143MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 8*143MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 9*146MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 9*146MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL APEX 6MM
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
STEM HUMERAL APEX 6MM
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
STEM HUMERAL APEX SIZE 7
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUMERAL APEX SIZE 7
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUMERAL REVERS SIZE 7
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUMERAL REVERS SIZE 7
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUMERAL REV SIZE 9
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUMERAL REV SIZE 9
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUMERAL SZ 13 P
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUMERAL SZ 13 P
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM HUM W/ POROCOAT SZ 6MM
|
Facility
|
IP
|
$21,400.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,782.03 |
| Max. Negotiated Rate |
$20,544.19 |
| Rate for Payer: Aetna Commercial |
$16,478.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,692.16
|
| Rate for Payer: Cash Price |
$10,700.10
|
| Rate for Payer: Cigna Commercial |
$17,762.17
|
| Rate for Payer: First Health Commercial |
$20,330.19
|
| Rate for Payer: Humana Commercial |
$18,190.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,548.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,420.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,832.18
|
| Rate for Payer: Ohio Health Group HMO |
$16,050.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.06
|
| Rate for Payer: PHCS Commercial |
$20,544.19
|
| Rate for Payer: United Healthcare All Payer |
$18,832.18
|
|
|
STEM HUM W/ POROCOAT SZ 6MM
|
Facility
|
OP
|
$21,400.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,782.03 |
| Max. Negotiated Rate |
$20,544.19 |
| Rate for Payer: Aetna Commercial |
$16,478.15
|
| Rate for Payer: Anthem Medicaid |
$7,359.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,692.16
|
| Rate for Payer: Cash Price |
$10,700.10
|
| Rate for Payer: Cigna Commercial |
$17,762.17
|
| Rate for Payer: First Health Commercial |
$20,330.19
|
| Rate for Payer: Humana Commercial |
$18,190.17
|
| Rate for Payer: Humana KY Medicaid |
$7,359.53
|
| Rate for Payer: Kentucky WC Medicaid |
$7,434.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,548.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,420.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,507.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,832.18
|
| Rate for Payer: Ohio Health Group HMO |
$16,050.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.06
|
| Rate for Payer: PHCS Commercial |
$20,544.19
|
| Rate for Payer: United Healthcare All Payer |
$18,832.18
|
|
|
STEM ILOK TIB TRAY 83MM
|
Facility
|
OP
|
$17,453.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.99 |
| Max. Negotiated Rate |
$16,755.61 |
| Rate for Payer: Aetna Commercial |
$13,439.40
|
| Rate for Payer: Anthem Medicaid |
$6,002.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,613.93
|
| Rate for Payer: Cash Price |
$8,726.88
|
| Rate for Payer: Cigna Commercial |
$14,486.62
|
| Rate for Payer: First Health Commercial |
$16,581.07
|
| Rate for Payer: Humana Commercial |
$14,835.70
|
| Rate for Payer: Humana KY Medicaid |
$6,002.35
|
| Rate for Payer: Kentucky WC Medicaid |
$6,063.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,312.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,880.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,236.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,359.31
|
| Rate for Payer: Ohio Health Group HMO |
$13,090.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,490.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,268.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,410.67
|
| Rate for Payer: PHCS Commercial |
$16,755.61
|
| Rate for Payer: United Healthcare All Payer |
$15,359.31
|
|
|
STEM ILOK TIB TRAY 83MM
|
Facility
|
IP
|
$17,453.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.99 |
| Max. Negotiated Rate |
$16,755.61 |
| Rate for Payer: Aetna Commercial |
$13,439.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,613.93
|
| Rate for Payer: Cash Price |
$8,726.88
|
| Rate for Payer: Cigna Commercial |
$14,486.62
|
| Rate for Payer: First Health Commercial |
$16,581.07
|
| Rate for Payer: Humana Commercial |
$14,835.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,312.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,880.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,236.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,359.31
|
| Rate for Payer: Ohio Health Group HMO |
$13,090.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,490.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,268.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,410.67
|
| Rate for Payer: PHCS Commercial |
$16,755.61
|
| Rate for Payer: United Healthcare All Payer |
$15,359.31
|
|
|
STEM IMPACTOR ROD
|
Facility
|
OP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem Medicaid |
$1,328.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Humana KY Medicaid |
$1,328.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
