|
STEM ARCS 28X250MM SPL TPR DST
|
Facility
|
OP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem Medicaid |
$9,082.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Humana KY Medicaid |
$9,082.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,175.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,264.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 28X250MM SPL TPR DST
|
Facility
|
IP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 29X150MM SPL TPR DST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 29X150MM SPL TPR DST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 29X190MM SPL TPR DST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 29X190MM SPL TPR DST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 29X250MM SPL TPR DST
|
Facility
|
IP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 29X250MM SPL TPR DST
|
Facility
|
OP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem Medicaid |
$9,082.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Humana KY Medicaid |
$9,082.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,175.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,264.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 30X150MM SPL TPR DST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 30X150MM SPL TPR DST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 30X190MM SPL TPR DST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 30X190MM SPL TPR DST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCS 30X250MM SPL TPR DST
|
Facility
|
IP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM ARCS 30X250MM SPL TPR DST
|
Facility
|
OP
|
$26,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,923.30 |
| Max. Negotiated Rate |
$25,354.56 |
| Rate for Payer: Aetna Commercial |
$20,336.47
|
| Rate for Payer: Anthem Medicaid |
$9,082.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,600.58
|
| Rate for Payer: Cash Price |
$13,205.50
|
| Rate for Payer: Cigna Commercial |
$21,921.13
|
| Rate for Payer: First Health Commercial |
$25,090.45
|
| Rate for Payer: Humana Commercial |
$22,449.35
|
| Rate for Payer: Humana KY Medicaid |
$9,082.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,175.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,657.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,491.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,923.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,264.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,241.68
|
| Rate for Payer: Ohio Health Group HMO |
$19,808.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,977.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,223.59
|
| Rate for Payer: PHCS Commercial |
$25,354.56
|
| Rate for Payer: United Healthcare All Payer |
$23,241.68
|
|
|
STEM BIOMET FIND PRI 80*12.5MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET FIND PRI 80*12.5MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET FINNED PRI 40MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET FINNED PRI 40MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET FINNED PRI 80*10MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET FINNED PRI 80*10MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET FINNED PRI 80*15MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET FINNED PRI 80*15MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET I-BEAM PRI 30MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET I-BEAM PRI 30MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
STEM BIOMET I-BEAM PRI 40MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
