|
STEM BMT SPLIND KNEE 20*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 20*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 20*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 20*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 22*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 22*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 22*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 22*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 SPLINED KNEE 10*80
|
Facility
|
IP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 10*80
|
Facility
|
OP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem Medicaid |
$3,752.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Humana KY Medicaid |
$3,752.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,790.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,827.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 12*120
|
Facility
|
OP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem Medicaid |
$3,752.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Humana KY Medicaid |
$3,752.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,790.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,827.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 12*120
|
Facility
|
IP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 12*160
|
Facility
|
IP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 12*160
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 12*200
|
Facility
|
IP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 12*200
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 12*80
|
Facility
|
OP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem Medicaid |
$3,752.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Humana KY Medicaid |
$3,752.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,790.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,827.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 12*80
|
Facility
|
IP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 14*120
|
Facility
|
OP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem Medicaid |
$3,752.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Humana KY Medicaid |
$3,752.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,790.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,827.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 14*120
|
Facility
|
IP
|
$10,911.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.58 |
| Max. Negotiated Rate |
$10,475.45 |
| Rate for Payer: Aetna Commercial |
$8,402.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.31
|
| Rate for Payer: Cash Price |
$5,455.97
|
| Rate for Payer: Cigna Commercial |
$9,056.90
|
| Rate for Payer: First Health Commercial |
$10,366.33
|
| Rate for Payer: Humana Commercial |
$9,275.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,947.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,602.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,183.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,729.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,493.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,529.23
|
| Rate for Payer: PHCS Commercial |
$10,475.45
|
| Rate for Payer: United Healthcare All Payer |
$9,602.50
|
|
|
STEM BMT SPLINED KNEE 14*160
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 14*160
|
Facility
|
IP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 14*200
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 14*200
|
Facility
|
IP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM BMT SPLINED KNEE 14*80
|
Facility
|
IP
|
$10,164.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,049.27 |
| Max. Negotiated Rate |
$9,757.65 |
| Rate for Payer: Aetna Commercial |
$7,826.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,928.09
|
| Rate for Payer: Cash Price |
$5,082.11
|
| Rate for Payer: Cigna Commercial |
$8,436.30
|
| Rate for Payer: First Health Commercial |
$9,656.01
|
| Rate for Payer: Humana Commercial |
$8,639.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,334.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,501.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,049.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,944.51
|
| Rate for Payer: Ohio Health Group HMO |
$7,623.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,131.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,842.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.31
|
| Rate for Payer: PHCS Commercial |
$9,757.65
|
| Rate for Payer: United Healthcare All Payer |
$8,944.51
|
|
