|
STEM SMOOTH EXT BIOMET 22X80
|
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 24X40
|
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 24X40
|
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 24X80
|
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 24X80
|
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 SMOOTHEXT BIOMT 12X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM SMOOTHEXT BIOMT 12X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM SMOOTHEXT BIOMT 14X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM SMOOTHEXT BIOMT 14X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM SPLINED OSS 10X120MM
|
Facility
|
IP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 10X120MM
|
Facility
|
OP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem Medicaid |
$5,508.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Humana KY Medicaid |
$5,508.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,564.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,619.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 11X120MM
|
Facility
|
IP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 11X120MM
|
Facility
|
OP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem Medicaid |
$5,508.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Humana KY Medicaid |
$5,508.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,564.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,619.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 12X120MM
|
Facility
|
OP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem Medicaid |
$5,508.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Humana KY Medicaid |
$5,508.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,564.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,619.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 12X120MM
|
Facility
|
IP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 13X120MM
|
Facility
|
IP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 13X120MM
|
Facility
|
OP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem Medicaid |
$5,508.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Humana KY Medicaid |
$5,508.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,564.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,619.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 14X120MM
|
Facility
|
OP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem Medicaid |
$5,508.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Humana KY Medicaid |
$5,508.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,564.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,619.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 14X120MM
|
Facility
|
IP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 9X120MM
|
Facility
|
OP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem Medicaid |
$5,508.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Humana KY Medicaid |
$5,508.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,564.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,619.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED OSS 9X120MM
|
Facility
|
IP
|
$16,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,805.40 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Aetna Commercial |
$12,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Cash Price |
$8,009.00
|
| Rate for Payer: Cigna Commercial |
$13,294.94
|
| Rate for Payer: First Health Commercial |
$15,217.10
|
| Rate for Payer: Humana Commercial |
$13,615.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,134.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,095.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,013.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,935.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,052.42
|
| Rate for Payer: PHCS Commercial |
$15,377.28
|
| Rate for Payer: United Healthcare All Payer |
$14,095.84
|
|
|
STEM SPLINED V2 BMT 10X40
|
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 SPLINED V2 BMT 10X40
|
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 SPLINED V2 BMT 10X80
|
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 SPLINED V2 BMT 10X80
|
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
|
|
