|
STEM SL-PLUS MIA LATERAL SZ 6
|
Facility
|
IP
|
$31,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,573.00 |
| Max. Negotiated Rate |
$30,633.60 |
| Rate for Payer: Aetna Commercial |
$24,570.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,889.80
|
| Rate for Payer: Cash Price |
$15,955.00
|
| Rate for Payer: Cigna Commercial |
$26,485.30
|
| Rate for Payer: First Health Commercial |
$30,314.50
|
| Rate for Payer: Humana Commercial |
$27,123.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,166.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,549.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,573.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,080.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,761.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,017.90
|
| Rate for Payer: PHCS Commercial |
$30,633.60
|
| Rate for Payer: United Healthcare All Payer |
$28,080.80
|
|
|
STEM SL-PLUS MIA LATERAL SZ 6
|
Facility
|
OP
|
$31,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,573.00 |
| Max. Negotiated Rate |
$30,633.60 |
| Rate for Payer: Aetna Commercial |
$24,570.70
|
| Rate for Payer: Anthem Medicaid |
$10,973.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,889.80
|
| Rate for Payer: Cash Price |
$15,955.00
|
| Rate for Payer: Cigna Commercial |
$26,485.30
|
| Rate for Payer: First Health Commercial |
$30,314.50
|
| Rate for Payer: Humana Commercial |
$27,123.50
|
| Rate for Payer: Humana KY Medicaid |
$10,973.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11,085.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,166.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,549.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,573.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,194.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,080.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,761.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,017.90
|
| Rate for Payer: PHCS Commercial |
$30,633.60
|
| Rate for Payer: United Healthcare All Payer |
$28,080.80
|
|
|
STEM SL-PLUS MIA LATERAL SZ 7
|
Facility
|
IP
|
$31,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,573.00 |
| Max. Negotiated Rate |
$30,633.60 |
| Rate for Payer: Aetna Commercial |
$24,570.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,889.80
|
| Rate for Payer: Cash Price |
$15,955.00
|
| Rate for Payer: Cigna Commercial |
$26,485.30
|
| Rate for Payer: First Health Commercial |
$30,314.50
|
| Rate for Payer: Humana Commercial |
$27,123.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,166.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,549.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,573.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,080.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,761.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,017.90
|
| Rate for Payer: PHCS Commercial |
$30,633.60
|
| Rate for Payer: United Healthcare All Payer |
$28,080.80
|
|
|
STEM SL-PLUS MIA LATERAL SZ 7
|
Facility
|
OP
|
$31,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,573.00 |
| Max. Negotiated Rate |
$30,633.60 |
| Rate for Payer: Aetna Commercial |
$24,570.70
|
| Rate for Payer: Anthem Medicaid |
$10,973.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,889.80
|
| Rate for Payer: Cash Price |
$15,955.00
|
| Rate for Payer: Cigna Commercial |
$26,485.30
|
| Rate for Payer: First Health Commercial |
$30,314.50
|
| Rate for Payer: Humana Commercial |
$27,123.50
|
| Rate for Payer: Humana KY Medicaid |
$10,973.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11,085.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,166.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,549.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,573.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,194.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,080.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,761.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,017.90
|
| Rate for Payer: PHCS Commercial |
$30,633.60
|
| Rate for Payer: United Healthcare All Payer |
$28,080.80
|
|
|
STEM SMF STIKTITE HO SZ 0
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMF STIKTITE HO SZ 0
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMF STIKTITE HO SZ -1
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMF STIKTITE HO SZ -1
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMF STIKTITE SZ 0
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMF STIKTITE SZ 0
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMF STIKTITE SZ -1
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMF STIKTITE SZ -1
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STEM SMOOTH EXT BIOMET 10X40
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 10X40
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 10X80
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 10X80
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 12X120
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 12X120
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 12X160
|
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 SMOOTH EXT BIOMET 12X160
|
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 SMOOTH EXT BIOMET 12X200
|
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 SMOOTH EXT BIOMET 12X200
|
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 SMOOTH EXT BIOMET 12X40
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 12X40
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM SMOOTH EXT BIOMET 12X80
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
