|
STEM BIOMET POR PRI TIB 71MM
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 71MM
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 75MM
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 75MM
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 79MM
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 79MM
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 83MM
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 83MM
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 87MM
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 87MM
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 91MM
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BIOMET POR PRI TIB 91MM
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
STEM BMETRIC 8MM
|
Facility
|
OP
|
$23,742.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,122.75 |
| Max. Negotiated Rate |
$22,792.80 |
| Rate for Payer: Aetna Commercial |
$18,281.72
|
| Rate for Payer: Anthem Medicaid |
$8,165.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,519.15
|
| Rate for Payer: Cash Price |
$11,871.25
|
| Rate for Payer: Cigna Commercial |
$19,706.28
|
| Rate for Payer: First Health Commercial |
$22,555.38
|
| Rate for Payer: Humana Commercial |
$20,181.12
|
| Rate for Payer: Humana KY Medicaid |
$8,165.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,248.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,468.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,521.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,122.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,328.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,893.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,806.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,994.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,655.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,382.33
|
| Rate for Payer: PHCS Commercial |
$22,792.80
|
| Rate for Payer: United Healthcare All Payer |
$20,893.40
|
|
|
STEM BMETRIC 8MM
|
Facility
|
IP
|
$23,742.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,122.75 |
| Max. Negotiated Rate |
$22,792.80 |
| Rate for Payer: Aetna Commercial |
$18,281.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,519.15
|
| Rate for Payer: Cash Price |
$11,871.25
|
| Rate for Payer: Cigna Commercial |
$19,706.28
|
| Rate for Payer: First Health Commercial |
$22,555.38
|
| Rate for Payer: Humana Commercial |
$20,181.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,468.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,521.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,122.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,893.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,806.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,994.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,655.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,382.33
|
| Rate for Payer: PHCS Commercial |
$22,792.80
|
| Rate for Payer: United Healthcare All Payer |
$20,893.40
|
|
|
STEM BMT SMOOTH KNE 12*200 BOW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 12*200 BOW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 14*200 BOW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 14*200 BOW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 16*160 BOW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 16*160 BOW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 16*200 BOW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 16*200 BOW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 18*160 BOW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 18*160 BOW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM BMT SMOOTH KNE 18*200 BOW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
