|
STEM BMT SMOOTH KNE 18*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 20*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 20*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 20*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 20*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 22*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 22*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 22*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 22*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 SPLIND KNEE 12*160 BO
|
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 SPLIND KNEE 12*160 BO
|
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 SPLIND KNEE 12*200 BO
|
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 SPLIND KNEE 12*200 BO
|
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 SPLIND KNEE 14*160 BO
|
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 SPLIND KNEE 14*160 BO
|
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 SPLIND KNEE 14*200 BO
|
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 SPLIND KNEE 14*200 BO
|
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 SPLIND KNEE 16*160 BO
|
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 SPLIND KNEE 16*160 BO
|
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 SPLIND KNEE 16*200 BO
|
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 SPLIND KNEE 16*200 BO
|
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 SPLIND KNEE 18*160 BO
|
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 SPLIND KNEE 18*160 BO
|
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 SPLIND KNEE 18*200 BO
|
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 SPLIND KNEE 18*200 BO
|
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
|
|
