|
STEM TAPRLOC MICROPLSTY XR 5.0
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 5.0
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 6.0
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 6.0
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 7.0
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 7.0
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 8.0
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 8.0
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 9.0
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM TAPRLOC MICROPLSTY XR 9.0
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STEM UNI REV APEX HUMRAL SZ 14
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
STEM UNI REV APEX HUMRAL SZ 14
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM UNIV 115*20MM FLUTED
|
Facility
|
IP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
STEM UNIV 115*20MM FLUTED
|
Facility
|
OP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem Medicaid |
$4,765.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Humana KY Medicaid |
$4,765.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,813.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,860.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
STEM UNIVERS REVERS SZ 8
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM UNIVERS REVERS SZ 8
|
Facility
|
IP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM WAGNER CONE 125^ 13MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 13MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 14MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 14MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 15MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 15MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 16MM
|
Facility
|
OP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem Medicaid |
$5,846.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Humana KY Medicaid |
$5,846.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,905.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 16MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
|
STEM WAGNER CONE 125^ 17MM
|
Facility
|
IP
|
$17,000.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.07 |
| Max. Negotiated Rate |
$16,320.23 |
| Rate for Payer: Aetna Commercial |
$13,090.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.19
|
| Rate for Payer: Cash Price |
$8,500.12
|
| Rate for Payer: Cigna Commercial |
$14,110.20
|
| Rate for Payer: First Health Commercial |
$16,150.23
|
| Rate for Payer: Humana Commercial |
$14,450.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.17
|
| Rate for Payer: PHCS Commercial |
$16,320.23
|
| Rate for Payer: United Healthcare All Payer |
$14,960.21
|
|
