|
UNIVERSAL STEM 115*14MM FLUTED
|
Facility
|
OP
|
$14,000.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,820.12 |
| Max. Negotiated Rate |
$13,440.85 |
| Rate for Payer: Aetna Commercial |
$10,780.69
|
| Rate for Payer: Anthem Medicaid |
$4,814.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,920.69
|
| Rate for Payer: Cash Price |
$7,000.44
|
| Rate for Payer: Cigna Commercial |
$11,620.74
|
| Rate for Payer: First Health Commercial |
$13,300.85
|
| Rate for Payer: Humana Commercial |
$11,900.76
|
| Rate for Payer: Humana KY Medicaid |
$4,814.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,863.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,480.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,332.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,200.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,911.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,320.78
|
| Rate for Payer: Ohio Health Group HMO |
$10,500.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,820.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,340.28
|
| Rate for Payer: PHCS Commercial |
$13,440.85
|
| Rate for Payer: United Healthcare All Payer |
$12,320.78
|
|
|
UNIVERSAL STEM 115*14MM FLUTED
|
Facility
|
IP
|
$14,000.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,820.12 |
| Max. Negotiated Rate |
$13,440.85 |
| Rate for Payer: Aetna Commercial |
$10,780.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,920.69
|
| Rate for Payer: Cash Price |
$7,000.44
|
| Rate for Payer: Cigna Commercial |
$11,620.74
|
| Rate for Payer: First Health Commercial |
$13,300.85
|
| Rate for Payer: Humana Commercial |
$11,900.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,480.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,332.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,200.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,320.78
|
| Rate for Payer: Ohio Health Group HMO |
$10,500.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,820.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,340.28
|
| Rate for Payer: PHCS Commercial |
$13,440.85
|
| Rate for Payer: United Healthcare All Payer |
$12,320.78
|
|
|
UNIVERSAL STEM 115*16MM FLUTED
|
Facility
|
IP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*16MM FLUTED
|
Facility
|
OP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem Medicaid |
$4,266.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Humana KY Medicaid |
$4,266.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,309.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,351.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*18MM FLUTED
|
Facility
|
OP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem Medicaid |
$4,266.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Humana KY Medicaid |
$4,266.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,309.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,351.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*18MM FLUTED
|
Facility
|
IP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*22MM FLUTED
|
Facility
|
IP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*22MM FLUTED
|
Facility
|
OP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem Medicaid |
$4,266.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Humana KY Medicaid |
$4,266.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,309.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,351.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*24MM FLUTED
|
Facility
|
OP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem Medicaid |
$4,677.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Humana KY Medicaid |
$4,677.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,724.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,770.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 115*24MM FLUTED
|
Facility
|
IP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 150*10MM FLUTED
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
UNIVERSAL STEM 150*10MM FLUTED
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
UNIVERSAL STEM 150*12MM FLUTED
|
Facility
|
IP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 150*12MM FLUTED
|
Facility
|
OP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem Medicaid |
$4,266.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Humana KY Medicaid |
$4,266.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,309.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,351.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 150*14MM FLUTED
|
Facility
|
IP
|
$14,012.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,821.66 |
| Max. Negotiated Rate |
$13,452.24 |
| Rate for Payer: Aetna Commercial |
$10,789.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,929.94
|
| Rate for Payer: Cash Price |
$7,006.38
|
| Rate for Payer: Cigna Commercial |
$11,630.58
|
| Rate for Payer: First Health Commercial |
$13,312.11
|
| Rate for Payer: Humana Commercial |
$11,910.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,490.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,341.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,203.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,331.22
|
| Rate for Payer: Ohio Health Group HMO |
$10,509.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,802.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,343.95
|
| Rate for Payer: PHCS Commercial |
$13,452.24
|
| Rate for Payer: United Healthcare All Payer |
$12,331.22
|
|
|
UNIVERSAL STEM 150*14MM FLUTED
|
Facility
|
OP
|
$14,012.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,821.66 |
| Max. Negotiated Rate |
$13,452.24 |
| Rate for Payer: Aetna Commercial |
$10,789.82
|
| Rate for Payer: Anthem Medicaid |
$4,818.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,929.94
|
| Rate for Payer: Cash Price |
$7,006.38
|
| Rate for Payer: Cigna Commercial |
$11,630.58
|
| Rate for Payer: First Health Commercial |
$13,312.11
|
| Rate for Payer: Humana Commercial |
$11,910.84
|
| Rate for Payer: Humana KY Medicaid |
$4,818.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,868.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,490.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,341.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,203.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,915.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,331.22
|
| Rate for Payer: Ohio Health Group HMO |
$10,509.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,802.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,343.95
|
| Rate for Payer: PHCS Commercial |
$13,452.24
|
| Rate for Payer: United Healthcare All Payer |
$12,331.22
|
|
|
UNIVERSAL STEM 150*16MM FLUTED
|
Facility
|
OP
|
$9,793.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.14 |
| Max. Negotiated Rate |
$9,401.66 |
| Rate for Payer: Aetna Commercial |
$7,540.92
|
| Rate for Payer: Anthem Medicaid |
$3,367.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,638.85
|
| Rate for Payer: Cash Price |
$4,896.70
|
| Rate for Payer: Cigna Commercial |
$8,128.52
|
| Rate for Payer: First Health Commercial |
$9,303.73
|
| Rate for Payer: Humana Commercial |
$8,324.39
|
| Rate for Payer: Humana KY Medicaid |
$3,367.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,402.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,030.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,227.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,938.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,435.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,618.19
|
| Rate for Payer: Ohio Health Group HMO |
$7,345.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,958.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,273.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,035.95
|
| Rate for Payer: PHCS Commercial |
$9,401.66
|
| Rate for Payer: United Healthcare All Payer |
$8,618.19
|
|
|
UNIVERSAL STEM 150*16MM FLUTED
|
Facility
|
IP
|
$9,793.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.14 |
| Max. Negotiated Rate |
$9,401.66 |
| Rate for Payer: Aetna Commercial |
$7,540.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,638.85
|
| Rate for Payer: Cash Price |
$4,896.70
|
| Rate for Payer: Cigna Commercial |
$8,128.52
|
| Rate for Payer: First Health Commercial |
$9,303.73
|
| Rate for Payer: Humana Commercial |
$8,324.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,030.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,227.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,938.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,618.19
|
| Rate for Payer: Ohio Health Group HMO |
$7,345.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,958.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,273.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,035.95
|
| Rate for Payer: PHCS Commercial |
$9,401.66
|
| Rate for Payer: United Healthcare All Payer |
$8,618.19
|
|
|
UNIVERSAL STEM 150*18MM FLUTED
|
Facility
|
OP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem Medicaid |
$4,677.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Humana KY Medicaid |
$4,677.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,724.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,770.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 150*18MM FLUTED
|
Facility
|
IP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 150*20MM FLUTED
|
Facility
|
IP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 150*20MM FLUTED
|
Facility
|
OP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem Medicaid |
$4,677.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Humana KY Medicaid |
$4,677.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,724.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,770.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 150*22MM FLUTED
|
Facility
|
IP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 150*22MM FLUTED
|
Facility
|
OP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem Medicaid |
$4,677.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Humana KY Medicaid |
$4,677.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,724.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,770.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
|
UNIVERSAL STEM 150*24MM FLUTED
|
Facility
|
OP
|
$13,600.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.04 |
| Max. Negotiated Rate |
$13,056.29 |
| Rate for Payer: Aetna Commercial |
$10,472.23
|
| Rate for Payer: Anthem Medicaid |
$4,677.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,608.23
|
| Rate for Payer: Cash Price |
$6,800.15
|
| Rate for Payer: Cigna Commercial |
$11,288.25
|
| Rate for Payer: First Health Commercial |
$12,920.28
|
| Rate for Payer: Humana Commercial |
$11,560.26
|
| Rate for Payer: Humana KY Medicaid |
$4,677.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,724.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,152.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,037.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,080.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,770.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,968.26
|
| Rate for Payer: Ohio Health Group HMO |
$10,200.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,216.09
|
| Rate for Payer: PHCS Commercial |
$13,056.29
|
| Rate for Payer: United Healthcare All Payer |
$11,968.26
|
|
