|
STEM TAPRLOC MCRPLSTY STD 15.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCRPLSTY STD 15.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCRPLSTY STD 16.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCRPLSTY STD 16.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCRPLSTY STD 17.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCRPLSTY STD 17.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCRPLSTY STD 18.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MCRPLSTY STD 18.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 4.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 4.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 5.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 5.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 6.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 6.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 7.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 7.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 8.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 8.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 9.0
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM TAPRLOC MICROPLSTY XR 9.0
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STEM UNI REV APEX HUMRAL SZ 14
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM UNI REV APEX HUMRAL SZ 14
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM UNIV 115*20MM FLUTED
|
Facility
|
IP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
STEM UNIV 115*20MM FLUTED
|
Facility
|
OP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem Medicaid |
$4,677.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Humana KY Medicaid |
$4,677.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,724.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,770.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
STEM UNIVERS REVERS SZ 8
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
