|
UNIVERSAL STEM 150*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 75*10MM FLUTED
|
Facility
|
OP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
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 75*10MM FLUTED
|
Facility
|
IP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
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 75*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 75*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 75*14MM 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 75*14MM 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 75*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 75*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 75*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 75*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 75*20MM 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 75*20MM 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 75*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 75*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 75*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 75*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
|
|
|
UNIVERS APEX STEM 5MM
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
UNIVERS APEX STEM 5MM
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
UNIVERS APEX STEM 6MM
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
UNIVERS APEX STEM 6MM
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
UNIVERS APEX STEM 7MM
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
UNIVERS APEX STEM 7MM
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
UNIVERS APEX STEM SZ 10MM
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
UNIVERS APEX STEM SZ 10MM
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
