|
TRI PRESS FIT STEM 10MM*150MM
|
Facility
|
IP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 10MM*150MM
|
Facility
|
OP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem Medicaid |
$2,458.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Humana KY Medicaid |
$2,458.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,483.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,507.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 11MM*100MM
|
Facility
|
IP
|
$8,019.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.58 |
| Max. Negotiated Rate |
$7,699.07 |
| Rate for Payer: Aetna Commercial |
$6,175.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.49
|
| Rate for Payer: Cash Price |
$4,009.93
|
| Rate for Payer: Cigna Commercial |
$6,656.48
|
| Rate for Payer: First Health Commercial |
$7,618.87
|
| Rate for Payer: Humana Commercial |
$6,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,576.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,918.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.16
|
| Rate for Payer: PHCS Commercial |
$7,699.07
|
| Rate for Payer: United Healthcare All Payer |
$7,057.48
|
|
|
TRI PRESS FIT STEM 11MM*100MM
|
Facility
|
OP
|
$8,019.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.58 |
| Max. Negotiated Rate |
$7,699.07 |
| Rate for Payer: Aetna Commercial |
$6,175.29
|
| Rate for Payer: Anthem Medicaid |
$2,758.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.49
|
| Rate for Payer: Cash Price |
$4,009.93
|
| Rate for Payer: Cigna Commercial |
$6,656.48
|
| Rate for Payer: First Health Commercial |
$7,618.87
|
| Rate for Payer: Humana Commercial |
$6,816.88
|
| Rate for Payer: Humana KY Medicaid |
$2,758.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,786.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,576.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,918.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,813.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.16
|
| Rate for Payer: PHCS Commercial |
$7,699.07
|
| Rate for Payer: United Healthcare All Payer |
$7,057.48
|
|
|
TRI PRESS FIT STEM 11MM*150MM
|
Facility
|
IP
|
$8,030.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,043.91 |
| Max. Negotiated Rate |
$7,708.88 |
| Rate for Payer: Aetna Commercial |
$6,183.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,263.46
|
| Rate for Payer: Cash Price |
$4,015.04
|
| Rate for Payer: Cigna Commercial |
$6,664.97
|
| Rate for Payer: First Health Commercial |
$7,628.58
|
| Rate for Payer: Humana Commercial |
$6,825.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,584.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,926.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,066.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,022.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,043.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,489.32
|
| Rate for Payer: PHCS Commercial |
$7,708.88
|
| Rate for Payer: United Healthcare All Payer |
$7,066.47
|
|
|
TRI PRESS FIT STEM 11MM*150MM
|
Facility
|
OP
|
$8,030.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,043.91 |
| Max. Negotiated Rate |
$7,708.88 |
| Rate for Payer: Aetna Commercial |
$6,183.16
|
| Rate for Payer: Anthem Medicaid |
$2,761.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,263.46
|
| Rate for Payer: Cash Price |
$4,015.04
|
| Rate for Payer: Cigna Commercial |
$6,664.97
|
| Rate for Payer: First Health Commercial |
$7,628.58
|
| Rate for Payer: Humana Commercial |
$6,825.57
|
| Rate for Payer: Humana KY Medicaid |
$2,761.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,789.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,584.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,926.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,816.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,066.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,022.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,043.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,489.32
|
| Rate for Payer: PHCS Commercial |
$7,708.88
|
| Rate for Payer: United Healthcare All Payer |
$7,066.47
|
|
|
TRI PRESS FIT STEM 12MM*100MM
|
Facility
|
IP
|
$7,217.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.33 |
| Max. Negotiated Rate |
$6,929.20 |
| Rate for Payer: Aetna Commercial |
$5,557.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,629.98
|
| Rate for Payer: Cash Price |
$3,608.96
|
| Rate for Payer: Cigna Commercial |
$5,990.87
|
| Rate for Payer: First Health Commercial |
$6,857.02
|
| Rate for Payer: Humana Commercial |
$6,135.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,918.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,351.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,413.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,237.56
|
| Rate for Payer: PHCS Commercial |
$6,929.20
|
| Rate for Payer: United Healthcare All Payer |
$6,351.77
|
|
|
TRI PRESS FIT STEM 12MM*100MM
|
Facility
|
OP
|
$7,217.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.33 |
| Max. Negotiated Rate |
$6,929.20 |
| Rate for Payer: Aetna Commercial |
$5,557.80
|
| Rate for Payer: Anthem Medicaid |
$2,482.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,629.98
|
| Rate for Payer: Cash Price |
$3,608.96
|
| Rate for Payer: Cigna Commercial |
$5,990.87
|
| Rate for Payer: First Health Commercial |
$6,857.02
|
| Rate for Payer: Humana Commercial |
$6,135.23
|
| Rate for Payer: Humana KY Medicaid |
$2,482.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,507.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,918.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,351.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,413.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,237.56
|
| Rate for Payer: PHCS Commercial |
$6,929.20
|
| Rate for Payer: United Healthcare All Payer |
$6,351.77
|
|
|
TRI PRESS FIT STEM 12MM*150MM
|
Facility
|
IP
|
$8,239.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.15 |
| Max. Negotiated Rate |
$7,910.01 |
| Rate for Payer: Aetna Commercial |
$6,344.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.88
|
| Rate for Payer: Cash Price |
$4,119.80
|
| Rate for Payer: Cigna Commercial |
$6,838.86
|
| Rate for Payer: First Health Commercial |
$7,827.61
|
| Rate for Payer: Humana Commercial |
$7,003.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,756.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,250.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.27
|
| Rate for Payer: PHCS Commercial |
$7,910.01
|
| Rate for Payer: United Healthcare All Payer |
$7,250.84
|
|
|
TRI PRESS FIT STEM 12MM*150MM
|
Facility
|
OP
|
$8,239.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.15 |
| Max. Negotiated Rate |
$7,910.01 |
| Rate for Payer: Aetna Commercial |
$6,344.48
|
| Rate for Payer: Anthem Medicaid |
$2,833.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.88
|
| Rate for Payer: Cash Price |
$4,119.80
|
| Rate for Payer: Cigna Commercial |
$6,838.86
|
| Rate for Payer: First Health Commercial |
$7,827.61
|
| Rate for Payer: Humana Commercial |
$7,003.65
|
| Rate for Payer: Humana KY Medicaid |
$2,833.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,756.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,250.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.27
|
| Rate for Payer: PHCS Commercial |
$7,910.01
|
| Rate for Payer: United Healthcare All Payer |
$7,250.84
|
|
|
TRI PRESS FIT STEM 13MM*100MM
|
Facility
|
OP
|
$8,019.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.58 |
| Max. Negotiated Rate |
$7,699.07 |
| Rate for Payer: Aetna Commercial |
$6,175.29
|
| Rate for Payer: Anthem Medicaid |
$2,758.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.49
|
| Rate for Payer: Cash Price |
$4,009.93
|
| Rate for Payer: Cigna Commercial |
$6,656.48
|
| Rate for Payer: First Health Commercial |
$7,618.87
|
| Rate for Payer: Humana Commercial |
$6,816.88
|
| Rate for Payer: Humana KY Medicaid |
$2,758.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,786.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,576.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,918.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,813.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.16
|
| Rate for Payer: PHCS Commercial |
$7,699.07
|
| Rate for Payer: United Healthcare All Payer |
$7,057.48
|
|
|
TRI PRESS FIT STEM 13MM*100MM
|
Facility
|
IP
|
$8,019.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.58 |
| Max. Negotiated Rate |
$7,699.07 |
| Rate for Payer: Aetna Commercial |
$6,175.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.49
|
| Rate for Payer: Cash Price |
$4,009.93
|
| Rate for Payer: Cigna Commercial |
$6,656.48
|
| Rate for Payer: First Health Commercial |
$7,618.87
|
| Rate for Payer: Humana Commercial |
$6,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,576.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,918.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.16
|
| Rate for Payer: PHCS Commercial |
$7,699.07
|
| Rate for Payer: United Healthcare All Payer |
$7,057.48
|
|
|
TRI PRESS FIT STEM 13MM*150MM
|
Facility
|
OP
|
$8,239.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.15 |
| Max. Negotiated Rate |
$7,910.01 |
| Rate for Payer: Aetna Commercial |
$6,344.48
|
| Rate for Payer: Anthem Medicaid |
$2,833.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.88
|
| Rate for Payer: Cash Price |
$4,119.80
|
| Rate for Payer: Cigna Commercial |
$6,838.86
|
| Rate for Payer: First Health Commercial |
$7,827.61
|
| Rate for Payer: Humana Commercial |
$7,003.65
|
| Rate for Payer: Humana KY Medicaid |
$2,833.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,756.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,250.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.27
|
| Rate for Payer: PHCS Commercial |
$7,910.01
|
| Rate for Payer: United Healthcare All Payer |
$7,250.84
|
|
|
TRI PRESS FIT STEM 13MM*150MM
|
Facility
|
IP
|
$8,239.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.15 |
| Max. Negotiated Rate |
$7,910.01 |
| Rate for Payer: Aetna Commercial |
$6,344.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.88
|
| Rate for Payer: Cash Price |
$4,119.80
|
| Rate for Payer: Cigna Commercial |
$6,838.86
|
| Rate for Payer: First Health Commercial |
$7,827.61
|
| Rate for Payer: Humana Commercial |
$7,003.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,756.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,250.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.27
|
| Rate for Payer: PHCS Commercial |
$7,910.01
|
| Rate for Payer: United Healthcare All Payer |
$7,250.84
|
|
|
TRI PRESS FIT STEM 14MM*100MM
|
Facility
|
IP
|
$8,615.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.97 |
| Max. Negotiated Rate |
$8,270.57 |
| Rate for Payer: Aetna Commercial |
$6,633.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.84
|
| Rate for Payer: Cash Price |
$4,307.59
|
| Rate for Payer: Cigna Commercial |
$7,150.60
|
| Rate for Payer: First Health Commercial |
$8,184.42
|
| Rate for Payer: Humana Commercial |
$7,322.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.71
|
| Rate for Payer: PHCS Commercial |
$8,270.57
|
| Rate for Payer: United Healthcare All Payer |
$7,581.36
|
|
|
TRI PRESS FIT STEM 14MM*100MM
|
Facility
|
OP
|
$8,615.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.97 |
| Max. Negotiated Rate |
$8,270.57 |
| Rate for Payer: Aetna Commercial |
$6,633.69
|
| Rate for Payer: Anthem Medicaid |
$2,962.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.84
|
| Rate for Payer: Cash Price |
$4,307.59
|
| Rate for Payer: Cigna Commercial |
$7,150.60
|
| Rate for Payer: First Health Commercial |
$8,184.42
|
| Rate for Payer: Humana Commercial |
$7,322.90
|
| Rate for Payer: Humana KY Medicaid |
$2,962.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.71
|
| Rate for Payer: PHCS Commercial |
$8,270.57
|
| Rate for Payer: United Healthcare All Payer |
$7,581.36
|
|
|
TRI PRESS FIT STEM 14MM*150MM
|
Facility
|
IP
|
$8,239.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.15 |
| Max. Negotiated Rate |
$7,910.01 |
| Rate for Payer: Aetna Commercial |
$6,344.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.88
|
| Rate for Payer: Cash Price |
$4,119.80
|
| Rate for Payer: Cigna Commercial |
$6,838.86
|
| Rate for Payer: First Health Commercial |
$7,827.61
|
| Rate for Payer: Humana Commercial |
$7,003.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,756.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,250.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.27
|
| Rate for Payer: PHCS Commercial |
$7,910.01
|
| Rate for Payer: United Healthcare All Payer |
$7,250.84
|
|
|
TRI PRESS FIT STEM 14MM*150MM
|
Facility
|
OP
|
$8,239.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.15 |
| Max. Negotiated Rate |
$7,910.01 |
| Rate for Payer: Aetna Commercial |
$6,344.48
|
| Rate for Payer: Anthem Medicaid |
$2,833.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.88
|
| Rate for Payer: Cash Price |
$4,119.80
|
| Rate for Payer: Cigna Commercial |
$6,838.86
|
| Rate for Payer: First Health Commercial |
$7,827.61
|
| Rate for Payer: Humana Commercial |
$7,003.65
|
| Rate for Payer: Humana KY Medicaid |
$2,833.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,756.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,250.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.27
|
| Rate for Payer: PHCS Commercial |
$7,910.01
|
| Rate for Payer: United Healthcare All Payer |
$7,250.84
|
|
|
TRI PRESS FIT STEM 15MM*100MM
|
Facility
|
OP
|
$8,615.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.97 |
| Max. Negotiated Rate |
$8,270.57 |
| Rate for Payer: Aetna Commercial |
$6,633.69
|
| Rate for Payer: Anthem Medicaid |
$2,962.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.84
|
| Rate for Payer: Cash Price |
$4,307.59
|
| Rate for Payer: Cigna Commercial |
$7,150.60
|
| Rate for Payer: First Health Commercial |
$8,184.42
|
| Rate for Payer: Humana Commercial |
$7,322.90
|
| Rate for Payer: Humana KY Medicaid |
$2,962.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.71
|
| Rate for Payer: PHCS Commercial |
$8,270.57
|
| Rate for Payer: United Healthcare All Payer |
$7,581.36
|
|
|
TRI PRESS FIT STEM 15MM*100MM
|
Facility
|
IP
|
$8,615.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.97 |
| Max. Negotiated Rate |
$8,270.57 |
| Rate for Payer: Aetna Commercial |
$6,633.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.84
|
| Rate for Payer: Cash Price |
$4,307.59
|
| Rate for Payer: Cigna Commercial |
$7,150.60
|
| Rate for Payer: First Health Commercial |
$8,184.42
|
| Rate for Payer: Humana Commercial |
$7,322.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.71
|
| Rate for Payer: PHCS Commercial |
$8,270.57
|
| Rate for Payer: United Healthcare All Payer |
$7,581.36
|
|
|
TRI PRESS FIT STEM 15MM*150MM
|
Facility
|
IP
|
$8,359.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.76 |
| Max. Negotiated Rate |
$8,025.29 |
| Rate for Payer: Aetna Commercial |
$6,436.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,520.55
|
| Rate for Payer: Cash Price |
$4,179.84
|
| Rate for Payer: Cigna Commercial |
$6,938.53
|
| Rate for Payer: First Health Commercial |
$7,941.70
|
| Rate for Payer: Humana Commercial |
$7,105.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,854.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,169.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,356.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,269.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,591.50
|
| Rate for Payer: PHCS Commercial |
$8,025.29
|
| Rate for Payer: United Healthcare All Payer |
$7,356.52
|
|
|
TRI PRESS FIT STEM 15MM*150MM
|
Facility
|
OP
|
$8,359.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.76 |
| Max. Negotiated Rate |
$8,025.29 |
| Rate for Payer: Aetna Commercial |
$6,436.95
|
| Rate for Payer: Anthem Medicaid |
$2,874.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,520.55
|
| Rate for Payer: Cash Price |
$4,179.84
|
| Rate for Payer: Cigna Commercial |
$6,938.53
|
| Rate for Payer: First Health Commercial |
$7,941.70
|
| Rate for Payer: Humana Commercial |
$7,105.73
|
| Rate for Payer: Humana KY Medicaid |
$2,874.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,904.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,854.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,169.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,356.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,269.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,591.50
|
| Rate for Payer: PHCS Commercial |
$8,025.29
|
| Rate for Payer: United Healthcare All Payer |
$7,356.52
|
|
|
TRI PRESS FIT STEM 16MM*100MM
|
Facility
|
IP
|
$8,615.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.97 |
| Max. Negotiated Rate |
$8,270.57 |
| Rate for Payer: Aetna Commercial |
$6,633.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.84
|
| Rate for Payer: Cash Price |
$4,307.59
|
| Rate for Payer: Cigna Commercial |
$7,150.60
|
| Rate for Payer: First Health Commercial |
$8,184.42
|
| Rate for Payer: Humana Commercial |
$7,322.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.71
|
| Rate for Payer: PHCS Commercial |
$8,270.57
|
| Rate for Payer: United Healthcare All Payer |
$7,581.36
|
|
|
TRI PRESS FIT STEM 16MM*100MM
|
Facility
|
OP
|
$8,615.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.97 |
| Max. Negotiated Rate |
$8,270.57 |
| Rate for Payer: Aetna Commercial |
$6,633.69
|
| Rate for Payer: Anthem Medicaid |
$2,962.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.84
|
| Rate for Payer: Cash Price |
$4,307.59
|
| Rate for Payer: Cigna Commercial |
$7,150.60
|
| Rate for Payer: First Health Commercial |
$8,184.42
|
| Rate for Payer: Humana Commercial |
$7,322.90
|
| Rate for Payer: Humana KY Medicaid |
$2,962.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.71
|
| Rate for Payer: PHCS Commercial |
$8,270.57
|
| Rate for Payer: United Healthcare All Payer |
$7,581.36
|
|
|
TRI PRESS FIT STEM 16MM*150MM
|
Facility
|
OP
|
$8,814.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.88 |
| Max. Negotiated Rate |
$8,461.89 |
| Rate for Payer: Aetna Commercial |
$6,787.14
|
| Rate for Payer: Anthem Medicaid |
$3,031.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.29
|
| Rate for Payer: Cash Price |
$4,407.24
|
| Rate for Payer: Cigna Commercial |
$7,316.01
|
| Rate for Payer: First Health Commercial |
$8,373.75
|
| Rate for Payer: Humana Commercial |
$7,492.30
|
| Rate for Payer: Humana KY Medicaid |
$3,031.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,227.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,756.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,610.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,762.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,732.49
|
| Rate for Payer: PHCS Commercial |
$8,461.89
|
| Rate for Payer: United Healthcare All Payer |
$7,756.73
|
|
