|
STEM BMT SPLINED KNEE 22*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 22*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 22*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 22*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 22*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 22*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 22*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 22*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 24*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 24*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 BOW COLLARED OSS 11X150
|
Facility
|
IP
|
$16,587.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,976.34 |
| Max. Negotiated Rate |
$15,924.29 |
| Rate for Payer: Aetna Commercial |
$12,772.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,938.48
|
| Rate for Payer: Cash Price |
$8,293.90
|
| Rate for Payer: Cigna Commercial |
$13,767.87
|
| Rate for Payer: First Health Commercial |
$15,758.41
|
| Rate for Payer: Humana Commercial |
$14,099.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,602.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,241.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,976.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,597.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,440.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,431.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,445.58
|
| Rate for Payer: PHCS Commercial |
$15,924.29
|
| Rate for Payer: United Healthcare All Payer |
$14,597.26
|
|
|
STEM BOW COLLARED OSS 11X150
|
Facility
|
OP
|
$16,587.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,976.34 |
| Max. Negotiated Rate |
$15,924.29 |
| Rate for Payer: Aetna Commercial |
$12,772.61
|
| Rate for Payer: Anthem Medicaid |
$5,704.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,938.48
|
| Rate for Payer: Cash Price |
$8,293.90
|
| Rate for Payer: Cigna Commercial |
$13,767.87
|
| Rate for Payer: First Health Commercial |
$15,758.41
|
| Rate for Payer: Humana Commercial |
$14,099.63
|
| Rate for Payer: Humana KY Medicaid |
$5,704.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,762.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,602.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,241.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,976.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,819.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,597.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,440.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,431.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,445.58
|
| Rate for Payer: PHCS Commercial |
$15,924.29
|
| Rate for Payer: United Healthcare All Payer |
$14,597.26
|
|
|
STEM BOW COLLARED OSS 11X225
|
Facility
|
IP
|
$16,587.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,976.34 |
| Max. Negotiated Rate |
$15,924.29 |
| Rate for Payer: Aetna Commercial |
$12,772.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,938.48
|
| Rate for Payer: Cash Price |
$8,293.90
|
| Rate for Payer: Cigna Commercial |
$13,767.87
|
| Rate for Payer: First Health Commercial |
$15,758.41
|
| Rate for Payer: Humana Commercial |
$14,099.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,602.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,241.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,976.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,597.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,440.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,431.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,445.58
|
| Rate for Payer: PHCS Commercial |
$15,924.29
|
| Rate for Payer: United Healthcare All Payer |
$14,597.26
|
|
|
STEM BOW COLLARED OSS 11X225
|
Facility
|
OP
|
$16,587.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,976.34 |
| Max. Negotiated Rate |
$15,924.29 |
| Rate for Payer: Aetna Commercial |
$12,772.61
|
| Rate for Payer: Anthem Medicaid |
$5,704.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,938.48
|
| Rate for Payer: Cash Price |
$8,293.90
|
| Rate for Payer: Cigna Commercial |
$13,767.87
|
| Rate for Payer: First Health Commercial |
$15,758.41
|
| Rate for Payer: Humana Commercial |
$14,099.63
|
| Rate for Payer: Humana KY Medicaid |
$5,704.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,762.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,602.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,241.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,976.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,819.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,597.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,440.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,431.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,445.58
|
| Rate for Payer: PHCS Commercial |
$15,924.29
|
| Rate for Payer: United Healthcare All Payer |
$14,597.26
|
|
|
STEM BOW COLLARED OSS 11X300
|
Facility
|
IP
|
$16,587.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,976.34 |
| Max. Negotiated Rate |
$15,924.29 |
| Rate for Payer: Aetna Commercial |
$12,772.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,938.48
|
| Rate for Payer: Cash Price |
$8,293.90
|
| Rate for Payer: Cigna Commercial |
$13,767.87
|
| Rate for Payer: First Health Commercial |
$15,758.41
|
| Rate for Payer: Humana Commercial |
$14,099.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,602.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,241.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,976.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,597.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,440.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,431.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,445.58
|
| Rate for Payer: PHCS Commercial |
$15,924.29
|
| Rate for Payer: United Healthcare All Payer |
$14,597.26
|
|
|
STEM BOW COLLARED OSS 11X300
|
Facility
|
OP
|
$16,587.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,976.34 |
| Max. Negotiated Rate |
$15,924.29 |
| Rate for Payer: Aetna Commercial |
$12,772.61
|
| Rate for Payer: Anthem Medicaid |
$5,704.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,938.48
|
| Rate for Payer: Cash Price |
$8,293.90
|
| Rate for Payer: Cigna Commercial |
$13,767.87
|
| Rate for Payer: First Health Commercial |
$15,758.41
|
| Rate for Payer: Humana Commercial |
$14,099.63
|
| Rate for Payer: Humana KY Medicaid |
$5,704.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,762.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,602.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,241.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,976.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,819.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,597.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,440.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,431.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,445.58
|
| Rate for Payer: PHCS Commercial |
$15,924.29
|
| Rate for Payer: United Healthcare All Payer |
$14,597.26
|
|
|
STEM BOWD BUL TIP DIST 13*150
|
Facility
|
OP
|
$23,112.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,933.75 |
| Max. Negotiated Rate |
$22,188.00 |
| Rate for Payer: Aetna Commercial |
$17,796.62
|
| Rate for Payer: Anthem Medicaid |
$7,948.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,027.75
|
| Rate for Payer: Cash Price |
$11,556.25
|
| Rate for Payer: Cigna Commercial |
$19,183.38
|
| Rate for Payer: First Health Commercial |
$21,956.88
|
| Rate for Payer: Humana Commercial |
$19,645.62
|
| Rate for Payer: Humana KY Medicaid |
$7,948.39
|
| Rate for Payer: Kentucky WC Medicaid |
$8,029.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,952.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,057.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,933.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,107.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,339.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,334.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,107.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,947.62
|
| Rate for Payer: PHCS Commercial |
$22,188.00
|
| Rate for Payer: United Healthcare All Payer |
$20,339.00
|
|
|
STEM BOWD BUL TIP DIST 13*150
|
Facility
|
IP
|
$23,112.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,933.75 |
| Max. Negotiated Rate |
$22,188.00 |
| Rate for Payer: Aetna Commercial |
$17,796.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,027.75
|
| Rate for Payer: Cash Price |
$11,556.25
|
| Rate for Payer: Cigna Commercial |
$19,183.38
|
| Rate for Payer: First Health Commercial |
$21,956.88
|
| Rate for Payer: Humana Commercial |
$19,645.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,952.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,057.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,933.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,339.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,334.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,107.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,947.62
|
| Rate for Payer: PHCS Commercial |
$22,188.00
|
| Rate for Payer: United Healthcare All Payer |
$20,339.00
|
|
|
STEM CEMENTED OSS IM 10X90MM
|
Facility
|
OP
|
$13,144.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,943.43 |
| Max. Negotiated Rate |
$12,618.97 |
| Rate for Payer: Aetna Commercial |
$10,121.47
|
| Rate for Payer: Anthem Medicaid |
$4,520.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,252.91
|
| Rate for Payer: Cash Price |
$6,572.38
|
| Rate for Payer: Cigna Commercial |
$10,910.15
|
| Rate for Payer: First Health Commercial |
$12,487.52
|
| Rate for Payer: Humana Commercial |
$11,173.05
|
| Rate for Payer: Humana KY Medicaid |
$4,520.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,566.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,778.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,700.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,943.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,611.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,567.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,858.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,515.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,435.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,069.88
|
| Rate for Payer: PHCS Commercial |
$12,618.97
|
| Rate for Payer: United Healthcare All Payer |
$11,567.39
|
|
|
STEM CEMENTED OSS IM 10X90MM
|
Facility
|
IP
|
$13,144.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,943.43 |
| Max. Negotiated Rate |
$12,618.97 |
| Rate for Payer: Aetna Commercial |
$10,121.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,252.91
|
| Rate for Payer: Cash Price |
$6,572.38
|
| Rate for Payer: Cigna Commercial |
$10,910.15
|
| Rate for Payer: First Health Commercial |
$12,487.52
|
| Rate for Payer: Humana Commercial |
$11,173.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,778.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,700.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,943.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,567.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,858.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,515.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,435.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,069.88
|
| Rate for Payer: PHCS Commercial |
$12,618.97
|
| Rate for Payer: United Healthcare All Payer |
$11,567.39
|
|
|
STEM CEMENTED OSS IM 11X150
|
Facility
|
OP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem Medicaid |
$4,531.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Humana KY Medicaid |
$4,531.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,577.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,622.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 11X150
|
Facility
|
IP
|
$13,176.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,952.94 |
| Max. Negotiated Rate |
$12,649.41 |
| Rate for Payer: Aetna Commercial |
$10,145.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,277.65
|
| Rate for Payer: Cash Price |
$6,588.23
|
| Rate for Payer: Cigna Commercial |
$10,936.47
|
| Rate for Payer: First Health Commercial |
$12,517.65
|
| Rate for Payer: Humana Commercial |
$11,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,804.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,724.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,952.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,595.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,882.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,541.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,091.76
|
| Rate for Payer: PHCS Commercial |
$12,649.41
|
| Rate for Payer: United Healthcare All Payer |
$11,595.29
|
|
|
STEM CEMENTED OSS IM 11X225
|
Facility
|
OP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem Medicaid |
$5,394.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Humana KY Medicaid |
$5,394.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,449.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,502.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
|
STEM CEMENTED OSS IM 11X225
|
Facility
|
IP
|
$15,686.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.94 |
| Max. Negotiated Rate |
$15,059.02 |
| Rate for Payer: Aetna Commercial |
$12,078.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,235.45
|
| Rate for Payer: Cash Price |
$7,843.24
|
| Rate for Payer: Cigna Commercial |
$13,019.78
|
| Rate for Payer: First Health Commercial |
$14,902.16
|
| Rate for Payer: Humana Commercial |
$13,333.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,862.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,576.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,804.10
|
| Rate for Payer: Ohio Health Group HMO |
$11,764.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,549.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,647.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,823.67
|
| Rate for Payer: PHCS Commercial |
$15,059.02
|
| Rate for Payer: United Healthcare All Payer |
$13,804.10
|
|
|
STEM CEMENTED OSS IM 11X300MM
|
Facility
|
IP
|
$16,219.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,865.78 |
| Max. Negotiated Rate |
$15,570.51 |
| Rate for Payer: Aetna Commercial |
$12,488.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,651.04
|
| Rate for Payer: Cash Price |
$8,109.64
|
| Rate for Payer: Cigna Commercial |
$13,462.00
|
| Rate for Payer: First Health Commercial |
$15,408.32
|
| Rate for Payer: Humana Commercial |
$13,786.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,299.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,969.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,865.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,272.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,164.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,975.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,110.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,191.30
|
| Rate for Payer: PHCS Commercial |
$15,570.51
|
| Rate for Payer: United Healthcare All Payer |
$14,272.97
|
|
