|
TRI PRESS FIT STEM 16MM*150MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TRI PRESS FIT STEM 17MM*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 17MM*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 17MM*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 17MM*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 18MM*100MM
|
Facility
|
OP
|
$7,644.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.76 |
| Max. Negotiated Rate |
$7,338.51 |
| Rate for Payer: Aetna Commercial |
$5,886.10
|
| Rate for Payer: Anthem Medicaid |
$2,628.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.54
|
| Rate for Payer: Cash Price |
$3,822.14
|
| Rate for Payer: Cigna Commercial |
$6,344.75
|
| Rate for Payer: First Health Commercial |
$7,262.07
|
| Rate for Payer: Humana Commercial |
$6,497.64
|
| Rate for Payer: Humana KY Medicaid |
$2,628.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,655.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,268.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,681.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,726.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,733.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,528.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,369.73
|
| Rate for Payer: PHCS Commercial |
$7,338.51
|
| Rate for Payer: United Healthcare All Payer |
$6,726.97
|
|
|
TRI PRESS FIT STEM 18MM*100MM
|
Facility
|
IP
|
$7,644.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.76 |
| Max. Negotiated Rate |
$7,338.51 |
| Rate for Payer: Aetna Commercial |
$5,886.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.54
|
| Rate for Payer: Cash Price |
$3,822.14
|
| Rate for Payer: Cigna Commercial |
$6,344.75
|
| Rate for Payer: First Health Commercial |
$7,262.07
|
| Rate for Payer: Humana Commercial |
$6,497.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,268.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,726.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,733.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,528.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,369.73
|
| Rate for Payer: PHCS Commercial |
$7,338.51
|
| Rate for Payer: United Healthcare All Payer |
$6,726.97
|
|
|
TRI PRESS FIT STEM 18MM*150MM
|
Facility
|
IP
|
$7,869.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.99 |
| Max. Negotiated Rate |
$7,554.36 |
| Rate for Payer: Aetna Commercial |
$6,059.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,137.91
|
| Rate for Payer: Cash Price |
$3,934.56
|
| Rate for Payer: Cigna Commercial |
$6,531.37
|
| Rate for Payer: First Health Commercial |
$7,475.66
|
| Rate for Payer: Humana Commercial |
$6,688.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,452.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,807.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,360.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,924.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,901.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,573.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.43
|
| Rate for Payer: PHCS Commercial |
$7,554.36
|
| Rate for Payer: United Healthcare All Payer |
$6,924.83
|
|
|
TRI PRESS FIT STEM 18MM*150MM
|
Facility
|
OP
|
$7,869.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.99 |
| Max. Negotiated Rate |
$7,554.36 |
| Rate for Payer: Aetna Commercial |
$6,059.22
|
| Rate for Payer: Anthem Medicaid |
$2,706.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,137.91
|
| Rate for Payer: Cash Price |
$3,934.56
|
| Rate for Payer: Cigna Commercial |
$6,531.37
|
| Rate for Payer: First Health Commercial |
$7,475.66
|
| Rate for Payer: Humana Commercial |
$6,688.75
|
| Rate for Payer: Humana KY Medicaid |
$2,706.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,733.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,452.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,807.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,360.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,760.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,924.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,901.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,573.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.43
|
| Rate for Payer: PHCS Commercial |
$7,554.36
|
| Rate for Payer: United Healthcare All Payer |
$6,924.83
|
|
|
TRI PRESS FIT STEM 19MM*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 19MM*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 19MM*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 19MM*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 20MM*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 20MM*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 20MM*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 20MM*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 21MM*100MM
|
Facility
|
OP
|
$8,175.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.84 |
| Max. Negotiated Rate |
$7,848.69 |
| Rate for Payer: Aetna Commercial |
$6,295.30
|
| Rate for Payer: Anthem Medicaid |
$2,811.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,377.06
|
| Rate for Payer: Cash Price |
$4,087.86
|
| Rate for Payer: Cigna Commercial |
$6,785.85
|
| Rate for Payer: First Health Commercial |
$7,766.93
|
| Rate for Payer: Humana Commercial |
$6,949.36
|
| Rate for Payer: Humana KY Medicaid |
$2,811.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,840.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,704.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,033.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,452.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,868.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,194.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,131.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,635.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,062.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.47
|
| Rate for Payer: PHCS Commercial |
$7,848.69
|
| Rate for Payer: United Healthcare All Payer |
$7,194.63
|
|
|
TRI PRESS FIT STEM 21MM*100MM
|
Facility
|
IP
|
$8,175.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.84 |
| Max. Negotiated Rate |
$7,848.69 |
| Rate for Payer: Aetna Commercial |
$6,295.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,377.06
|
| Rate for Payer: Cash Price |
$4,087.86
|
| Rate for Payer: Cigna Commercial |
$6,785.85
|
| Rate for Payer: First Health Commercial |
$7,766.93
|
| Rate for Payer: Humana Commercial |
$6,949.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,704.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,033.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,452.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,194.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,131.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,635.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,062.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.47
|
| Rate for Payer: PHCS Commercial |
$7,848.69
|
| Rate for Payer: United Healthcare All Payer |
$7,194.63
|
|
|
TRI PRESS FIT STEM 21MM*150MM
|
Facility
|
IP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI PRESS FIT STEM 21MM*150MM
|
Facility
|
OP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem Medicaid |
$2,805.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Humana KY Medicaid |
$2,805.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI PRESS FIT STEM 22MM*100MM
|
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 22MM*100MM
|
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 22MM*150MM
|
Facility
|
OP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem Medicaid |
$2,805.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Humana KY Medicaid |
$2,805.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI PRESS FIT STEM 22MM*150MM
|
Facility
|
IP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
