|
TRI PRESS FIT STEM 10MM*100MM
|
Facility
|
IP
|
$8,219.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.96 |
| Max. Negotiated Rate |
$7,891.07 |
| Rate for Payer: Aetna Commercial |
$6,329.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.49
|
| Rate for Payer: Cash Price |
$4,109.93
|
| Rate for Payer: Cigna Commercial |
$6,822.48
|
| Rate for Payer: First Health Commercial |
$7,808.87
|
| Rate for Payer: Humana Commercial |
$6,986.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,465.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,164.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,575.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,151.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,671.70
|
| Rate for Payer: PHCS Commercial |
$7,891.07
|
| Rate for Payer: United Healthcare All Payer |
$7,233.48
|
|
|
TRI PRESS FIT STEM 10MM*100MM
|
Facility
|
OP
|
$8,219.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.96 |
| Max. Negotiated Rate |
$7,891.07 |
| Rate for Payer: Aetna Commercial |
$6,329.29
|
| Rate for Payer: Anthem Medicaid |
$2,826.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.49
|
| Rate for Payer: Cash Price |
$4,109.93
|
| Rate for Payer: Cigna Commercial |
$6,822.48
|
| Rate for Payer: First Health Commercial |
$7,808.87
|
| Rate for Payer: Humana Commercial |
$6,986.88
|
| Rate for Payer: Humana KY Medicaid |
$2,826.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,465.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,164.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,575.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,151.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,671.70
|
| Rate for Payer: PHCS Commercial |
$7,891.07
|
| Rate for Payer: United Healthcare All Payer |
$7,233.48
|
|
|
TRI PRESS FIT STEM 10MM*150MM
|
Facility
|
IP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 10MM*150MM
|
Facility
|
OP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem Medicaid |
$2,527.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Humana KY Medicaid |
$2,527.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,553.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,578.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 11MM*100MM
|
Facility
|
IP
|
$7,417.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.38 |
| Max. Negotiated Rate |
$7,121.20 |
| Rate for Payer: Aetna Commercial |
$5,711.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,785.98
|
| Rate for Payer: Cash Price |
$3,708.96
|
| Rate for Payer: Cigna Commercial |
$6,156.87
|
| Rate for Payer: First Health Commercial |
$7,047.02
|
| Rate for Payer: Humana Commercial |
$6,305.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,082.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,474.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,527.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,563.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,934.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,453.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.36
|
| Rate for Payer: PHCS Commercial |
$7,121.20
|
| Rate for Payer: United Healthcare All Payer |
$6,527.77
|
|
|
TRI PRESS FIT STEM 11MM*100MM
|
Facility
|
OP
|
$7,417.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.38 |
| Max. Negotiated Rate |
$7,121.20 |
| Rate for Payer: Aetna Commercial |
$5,711.80
|
| Rate for Payer: Anthem Medicaid |
$2,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,785.98
|
| Rate for Payer: Cash Price |
$3,708.96
|
| Rate for Payer: Cigna Commercial |
$6,156.87
|
| Rate for Payer: First Health Commercial |
$7,047.02
|
| Rate for Payer: Humana Commercial |
$6,305.23
|
| Rate for Payer: Humana KY Medicaid |
$2,551.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,576.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,082.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,474.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,527.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,563.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,934.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,453.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.36
|
| Rate for Payer: PHCS Commercial |
$7,121.20
|
| Rate for Payer: United Healthcare All Payer |
$6,527.77
|
|
|
TRI PRESS FIT STEM 11MM*150MM
|
Facility
|
OP
|
$8,230.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.02 |
| Max. Negotiated Rate |
$7,900.88 |
| Rate for Payer: Aetna Commercial |
$6,337.16
|
| Rate for Payer: Anthem Medicaid |
$2,830.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,419.46
|
| Rate for Payer: Cash Price |
$4,115.04
|
| Rate for Payer: Cigna Commercial |
$6,830.97
|
| Rate for Payer: First Health Commercial |
$7,818.58
|
| Rate for Payer: Humana Commercial |
$6,995.57
|
| Rate for Payer: Humana KY Medicaid |
$2,830.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,859.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,887.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,242.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,584.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,160.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,678.76
|
| Rate for Payer: PHCS Commercial |
$7,900.88
|
| Rate for Payer: United Healthcare All Payer |
$7,242.47
|
|
|
TRI PRESS FIT STEM 11MM*150MM
|
Facility
|
IP
|
$8,230.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.02 |
| Max. Negotiated Rate |
$7,900.88 |
| Rate for Payer: Aetna Commercial |
$6,337.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,419.46
|
| Rate for Payer: Cash Price |
$4,115.04
|
| Rate for Payer: Cigna Commercial |
$6,830.97
|
| Rate for Payer: First Health Commercial |
$7,818.58
|
| Rate for Payer: Humana Commercial |
$6,995.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,242.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,584.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,160.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,678.76
|
| Rate for Payer: PHCS Commercial |
$7,900.88
|
| Rate for Payer: United Healthcare All Payer |
$7,242.47
|
|
|
TRI PRESS FIT STEM 12MM*100MM
|
Facility
|
OP
|
$7,417.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.38 |
| Max. Negotiated Rate |
$7,121.20 |
| Rate for Payer: Aetna Commercial |
$5,711.80
|
| Rate for Payer: Anthem Medicaid |
$2,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,785.98
|
| Rate for Payer: Cash Price |
$3,708.96
|
| Rate for Payer: Cigna Commercial |
$6,156.87
|
| Rate for Payer: First Health Commercial |
$7,047.02
|
| Rate for Payer: Humana Commercial |
$6,305.23
|
| Rate for Payer: Humana KY Medicaid |
$2,551.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,576.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,082.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,474.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,527.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,563.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,934.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,453.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.36
|
| Rate for Payer: PHCS Commercial |
$7,121.20
|
| Rate for Payer: United Healthcare All Payer |
$6,527.77
|
|
|
TRI PRESS FIT STEM 12MM*100MM
|
Facility
|
IP
|
$7,417.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.38 |
| Max. Negotiated Rate |
$7,121.20 |
| Rate for Payer: Aetna Commercial |
$5,711.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,785.98
|
| Rate for Payer: Cash Price |
$3,708.96
|
| Rate for Payer: Cigna Commercial |
$6,156.87
|
| Rate for Payer: First Health Commercial |
$7,047.02
|
| Rate for Payer: Humana Commercial |
$6,305.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,082.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,474.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,527.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,563.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,934.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,453.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.36
|
| Rate for Payer: PHCS Commercial |
$7,121.20
|
| Rate for Payer: United Healthcare All Payer |
$6,527.77
|
|
|
TRI PRESS FIT STEM 12MM*150MM
|
Facility
|
OP
|
$8,439.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.88 |
| Max. Negotiated Rate |
$8,102.01 |
| Rate for Payer: Aetna Commercial |
$6,498.48
|
| Rate for Payer: Anthem Medicaid |
$2,902.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,582.88
|
| Rate for Payer: Cash Price |
$4,219.80
|
| Rate for Payer: Cigna Commercial |
$7,004.86
|
| Rate for Payer: First Health Commercial |
$8,017.61
|
| Rate for Payer: Humana Commercial |
$7,173.65
|
| Rate for Payer: Humana KY Medicaid |
$2,902.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,931.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,920.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,531.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,960.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,426.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,751.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,342.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.32
|
| Rate for Payer: PHCS Commercial |
$8,102.01
|
| Rate for Payer: United Healthcare All Payer |
$7,426.84
|
|
|
TRI PRESS FIT STEM 12MM*150MM
|
Facility
|
IP
|
$8,439.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.88 |
| Max. Negotiated Rate |
$8,102.01 |
| Rate for Payer: Aetna Commercial |
$6,498.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,582.88
|
| Rate for Payer: Cash Price |
$4,219.80
|
| Rate for Payer: Cigna Commercial |
$7,004.86
|
| Rate for Payer: First Health Commercial |
$8,017.61
|
| Rate for Payer: Humana Commercial |
$7,173.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,920.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,531.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,426.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,751.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,342.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.32
|
| Rate for Payer: PHCS Commercial |
$8,102.01
|
| Rate for Payer: United Healthcare All Payer |
$7,426.84
|
|
|
TRI PRESS FIT STEM 13MM*100MM
|
Facility
|
IP
|
$8,219.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.96 |
| Max. Negotiated Rate |
$7,891.07 |
| Rate for Payer: Aetna Commercial |
$6,329.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.49
|
| Rate for Payer: Cash Price |
$4,109.93
|
| Rate for Payer: Cigna Commercial |
$6,822.48
|
| Rate for Payer: First Health Commercial |
$7,808.87
|
| Rate for Payer: Humana Commercial |
$6,986.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,465.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,164.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,575.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,151.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,671.70
|
| Rate for Payer: PHCS Commercial |
$7,891.07
|
| Rate for Payer: United Healthcare All Payer |
$7,233.48
|
|
|
TRI PRESS FIT STEM 13MM*100MM
|
Facility
|
OP
|
$8,219.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.96 |
| Max. Negotiated Rate |
$7,891.07 |
| Rate for Payer: Aetna Commercial |
$6,329.29
|
| Rate for Payer: Anthem Medicaid |
$2,826.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.49
|
| Rate for Payer: Cash Price |
$4,109.93
|
| Rate for Payer: Cigna Commercial |
$6,822.48
|
| Rate for Payer: First Health Commercial |
$7,808.87
|
| Rate for Payer: Humana Commercial |
$6,986.88
|
| Rate for Payer: Humana KY Medicaid |
$2,826.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,465.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,164.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,575.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,151.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,671.70
|
| Rate for Payer: PHCS Commercial |
$7,891.07
|
| Rate for Payer: United Healthcare All Payer |
$7,233.48
|
|
|
TRI PRESS FIT STEM 13MM*150MM
|
Facility
|
OP
|
$8,439.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.88 |
| Max. Negotiated Rate |
$8,102.01 |
| Rate for Payer: Aetna Commercial |
$6,498.48
|
| Rate for Payer: Anthem Medicaid |
$2,902.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,582.88
|
| Rate for Payer: Cash Price |
$4,219.80
|
| Rate for Payer: Cigna Commercial |
$7,004.86
|
| Rate for Payer: First Health Commercial |
$8,017.61
|
| Rate for Payer: Humana Commercial |
$7,173.65
|
| Rate for Payer: Humana KY Medicaid |
$2,902.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,931.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,920.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,531.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,960.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,426.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,751.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,342.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.32
|
| Rate for Payer: PHCS Commercial |
$8,102.01
|
| Rate for Payer: United Healthcare All Payer |
$7,426.84
|
|
|
TRI PRESS FIT STEM 13MM*150MM
|
Facility
|
IP
|
$8,439.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.88 |
| Max. Negotiated Rate |
$8,102.01 |
| Rate for Payer: Aetna Commercial |
$6,498.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,582.88
|
| Rate for Payer: Cash Price |
$4,219.80
|
| Rate for Payer: Cigna Commercial |
$7,004.86
|
| Rate for Payer: First Health Commercial |
$8,017.61
|
| Rate for Payer: Humana Commercial |
$7,173.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,920.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,531.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,426.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,751.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,342.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.32
|
| Rate for Payer: PHCS Commercial |
$8,102.01
|
| Rate for Payer: United Healthcare All Payer |
$7,426.84
|
|
|
TRI PRESS FIT STEM 14MM*100MM
|
Facility
|
OP
|
$7,417.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.38 |
| Max. Negotiated Rate |
$7,121.20 |
| Rate for Payer: Aetna Commercial |
$5,711.80
|
| Rate for Payer: Anthem Medicaid |
$2,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,785.98
|
| Rate for Payer: Cash Price |
$3,708.96
|
| Rate for Payer: Cigna Commercial |
$6,156.87
|
| Rate for Payer: First Health Commercial |
$7,047.02
|
| Rate for Payer: Humana Commercial |
$6,305.23
|
| Rate for Payer: Humana KY Medicaid |
$2,551.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,576.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,082.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,474.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,527.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,563.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,934.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,453.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.36
|
| Rate for Payer: PHCS Commercial |
$7,121.20
|
| Rate for Payer: United Healthcare All Payer |
$6,527.77
|
|
|
TRI PRESS FIT STEM 14MM*100MM
|
Facility
|
IP
|
$7,417.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.38 |
| Max. Negotiated Rate |
$7,121.20 |
| Rate for Payer: Aetna Commercial |
$5,711.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,785.98
|
| Rate for Payer: Cash Price |
$3,708.96
|
| Rate for Payer: Cigna Commercial |
$6,156.87
|
| Rate for Payer: First Health Commercial |
$7,047.02
|
| Rate for Payer: Humana Commercial |
$6,305.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,082.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,474.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,527.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,563.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,934.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,453.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.36
|
| Rate for Payer: PHCS Commercial |
$7,121.20
|
| Rate for Payer: United Healthcare All Payer |
$6,527.77
|
|
|
TRI PRESS FIT STEM 14MM*150MM
|
Facility
|
OP
|
$8,439.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.88 |
| Max. Negotiated Rate |
$8,102.01 |
| Rate for Payer: Aetna Commercial |
$6,498.48
|
| Rate for Payer: Anthem Medicaid |
$2,902.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,582.88
|
| Rate for Payer: Cash Price |
$4,219.80
|
| Rate for Payer: Cigna Commercial |
$7,004.86
|
| Rate for Payer: First Health Commercial |
$8,017.61
|
| Rate for Payer: Humana Commercial |
$7,173.65
|
| Rate for Payer: Humana KY Medicaid |
$2,902.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,931.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,920.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,531.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,960.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,426.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,751.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,342.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.32
|
| Rate for Payer: PHCS Commercial |
$8,102.01
|
| Rate for Payer: United Healthcare All Payer |
$7,426.84
|
|
|
TRI PRESS FIT STEM 14MM*150MM
|
Facility
|
IP
|
$8,439.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.88 |
| Max. Negotiated Rate |
$8,102.01 |
| Rate for Payer: Aetna Commercial |
$6,498.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,582.88
|
| Rate for Payer: Cash Price |
$4,219.80
|
| Rate for Payer: Cigna Commercial |
$7,004.86
|
| Rate for Payer: First Health Commercial |
$8,017.61
|
| Rate for Payer: Humana Commercial |
$7,173.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,920.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,531.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,426.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,751.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,342.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.32
|
| Rate for Payer: PHCS Commercial |
$8,102.01
|
| Rate for Payer: United Healthcare All Payer |
$7,426.84
|
|
|
TRI PRESS FIT STEM 15MM*100MM
|
Facility
|
OP
|
$8,815.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.55 |
| Max. Negotiated Rate |
$8,462.57 |
| Rate for Payer: Aetna Commercial |
$6,787.69
|
| Rate for Payer: Anthem Medicaid |
$3,031.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.84
|
| Rate for Payer: Cash Price |
$4,407.59
|
| Rate for Payer: Cigna Commercial |
$7,316.60
|
| Rate for Payer: First Health Commercial |
$8,374.42
|
| Rate for Payer: Humana Commercial |
$7,492.90
|
| Rate for Payer: Humana KY Medicaid |
$3,031.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,228.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,757.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,611.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,052.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,669.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,082.47
|
| Rate for Payer: PHCS Commercial |
$8,462.57
|
| Rate for Payer: United Healthcare All Payer |
$7,757.36
|
|
|
TRI PRESS FIT STEM 15MM*100MM
|
Facility
|
IP
|
$8,815.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.55 |
| Max. Negotiated Rate |
$8,462.57 |
| Rate for Payer: Aetna Commercial |
$6,787.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.84
|
| Rate for Payer: Cash Price |
$4,407.59
|
| Rate for Payer: Cigna Commercial |
$7,316.60
|
| Rate for Payer: First Health Commercial |
$8,374.42
|
| Rate for Payer: Humana Commercial |
$7,492.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,228.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,757.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,611.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,052.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,669.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,082.47
|
| Rate for Payer: PHCS Commercial |
$8,462.57
|
| Rate for Payer: United Healthcare All Payer |
$7,757.36
|
|
|
TRI PRESS FIT STEM 15MM*150MM
|
Facility
|
IP
|
$8,559.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.90 |
| Max. Negotiated Rate |
$8,217.29 |
| Rate for Payer: Aetna Commercial |
$6,590.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,676.55
|
| Rate for Payer: Cash Price |
$4,279.84
|
| Rate for Payer: Cigna Commercial |
$7,104.53
|
| Rate for Payer: First Health Commercial |
$8,131.70
|
| Rate for Payer: Humana Commercial |
$7,275.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,018.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,317.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,532.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,419.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,847.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,446.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,906.18
|
| Rate for Payer: PHCS Commercial |
$8,217.29
|
| Rate for Payer: United Healthcare All Payer |
$7,532.52
|
|
|
TRI PRESS FIT STEM 15MM*150MM
|
Facility
|
OP
|
$8,559.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.90 |
| Max. Negotiated Rate |
$8,217.29 |
| Rate for Payer: Aetna Commercial |
$6,590.95
|
| Rate for Payer: Anthem Medicaid |
$2,943.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,676.55
|
| Rate for Payer: Cash Price |
$4,279.84
|
| Rate for Payer: Cigna Commercial |
$7,104.53
|
| Rate for Payer: First Health Commercial |
$8,131.70
|
| Rate for Payer: Humana Commercial |
$7,275.73
|
| Rate for Payer: Humana KY Medicaid |
$2,943.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,973.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,018.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,317.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,002.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,532.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,419.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,847.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,446.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,906.18
|
| Rate for Payer: PHCS Commercial |
$8,217.29
|
| Rate for Payer: United Healthcare All Payer |
$7,532.52
|
|
|
TRI PRESS FIT STEM 16MM*100MM
|
Facility
|
IP
|
$8,815.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.55 |
| Max. Negotiated Rate |
$8,462.57 |
| Rate for Payer: Aetna Commercial |
$6,787.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.84
|
| Rate for Payer: Cash Price |
$4,407.59
|
| Rate for Payer: Cigna Commercial |
$7,316.60
|
| Rate for Payer: First Health Commercial |
$8,374.42
|
| Rate for Payer: Humana Commercial |
$7,492.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,228.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,757.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,611.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,052.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,669.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,082.47
|
| Rate for Payer: PHCS Commercial |
$8,462.57
|
| Rate for Payer: United Healthcare All Payer |
$7,757.36
|
|
