|
TRI PRESS FIT STEM 16MM*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 16MM*150MM
|
Facility
|
IP
|
$9,014.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,704.34 |
| Max. Negotiated Rate |
$8,653.89 |
| Rate for Payer: Aetna Commercial |
$6,941.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,031.29
|
| Rate for Payer: Cash Price |
$4,507.24
|
| Rate for Payer: Cigna Commercial |
$7,482.01
|
| Rate for Payer: First Health Commercial |
$8,563.75
|
| Rate for Payer: Humana Commercial |
$7,662.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,391.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,652.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,704.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,932.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,760.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,211.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,842.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,219.98
|
| Rate for Payer: PHCS Commercial |
$8,653.89
|
| Rate for Payer: United Healthcare All Payer |
$7,932.73
|
|
|
TRI PRESS FIT STEM 16MM*150MM
|
Facility
|
OP
|
$9,014.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,704.34 |
| Max. Negotiated Rate |
$8,653.89 |
| Rate for Payer: Aetna Commercial |
$6,941.14
|
| Rate for Payer: Anthem Medicaid |
$3,100.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,031.29
|
| Rate for Payer: Cash Price |
$4,507.24
|
| Rate for Payer: Cigna Commercial |
$7,482.01
|
| Rate for Payer: First Health Commercial |
$8,563.75
|
| Rate for Payer: Humana Commercial |
$7,662.30
|
| Rate for Payer: Humana KY Medicaid |
$3,100.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,131.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,391.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,652.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,704.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,162.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,932.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,760.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,211.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,842.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,219.98
|
| Rate for Payer: PHCS Commercial |
$8,653.89
|
| Rate for Payer: United Healthcare All Payer |
$7,932.73
|
|
|
TRI PRESS FIT STEM 17MM*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 17MM*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 17MM*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 17MM*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 18MM*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 18MM*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 18MM*150MM
|
Facility
|
OP
|
$7,886.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.99 |
| Max. Negotiated Rate |
$7,571.16 |
| Rate for Payer: Aetna Commercial |
$6,072.70
|
| Rate for Payer: Anthem Medicaid |
$2,712.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,151.56
|
| Rate for Payer: Cash Price |
$3,943.31
|
| Rate for Payer: Cigna Commercial |
$6,545.89
|
| Rate for Payer: First Health Commercial |
$7,492.29
|
| Rate for Payer: Humana Commercial |
$6,703.63
|
| Rate for Payer: Humana KY Medicaid |
$2,712.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,739.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,467.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,820.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,766.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,940.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,914.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,309.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,861.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,441.77
|
| Rate for Payer: PHCS Commercial |
$7,571.16
|
| Rate for Payer: United Healthcare All Payer |
$6,940.23
|
|
|
TRI PRESS FIT STEM 18MM*150MM
|
Facility
|
IP
|
$7,886.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.99 |
| Max. Negotiated Rate |
$7,571.16 |
| Rate for Payer: Aetna Commercial |
$6,072.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,151.56
|
| Rate for Payer: Cash Price |
$3,943.31
|
| Rate for Payer: Cigna Commercial |
$6,545.89
|
| Rate for Payer: First Health Commercial |
$7,492.29
|
| Rate for Payer: Humana Commercial |
$6,703.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,467.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,820.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,940.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,914.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,309.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,861.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,441.77
|
| Rate for Payer: PHCS Commercial |
$7,571.16
|
| Rate for Payer: United Healthcare All Payer |
$6,940.23
|
|
|
TRI PRESS FIT STEM 19MM*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 19MM*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 19MM*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 19MM*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 20MM*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 20MM*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 20MM*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 20MM*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 21MM*100MM
|
Facility
|
IP
|
$8,375.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.72 |
| Max. Negotiated Rate |
$8,040.69 |
| Rate for Payer: Aetna Commercial |
$6,449.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,533.06
|
| Rate for Payer: Cash Price |
$4,187.86
|
| Rate for Payer: Cigna Commercial |
$6,951.85
|
| Rate for Payer: First Health Commercial |
$7,956.93
|
| Rate for Payer: Humana Commercial |
$7,119.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,868.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,181.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,512.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,370.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,281.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,700.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,286.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,779.25
|
| Rate for Payer: PHCS Commercial |
$8,040.69
|
| Rate for Payer: United Healthcare All Payer |
$7,370.63
|
|
|
TRI PRESS FIT STEM 21MM*100MM
|
Facility
|
OP
|
$8,375.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.72 |
| Max. Negotiated Rate |
$8,040.69 |
| Rate for Payer: Aetna Commercial |
$6,449.30
|
| Rate for Payer: Anthem Medicaid |
$2,880.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,533.06
|
| Rate for Payer: Cash Price |
$4,187.86
|
| Rate for Payer: Cigna Commercial |
$6,951.85
|
| Rate for Payer: First Health Commercial |
$7,956.93
|
| Rate for Payer: Humana Commercial |
$7,119.36
|
| Rate for Payer: Humana KY Medicaid |
$2,880.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,909.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,868.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,181.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,512.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,370.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,281.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,700.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,286.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,779.25
|
| Rate for Payer: PHCS Commercial |
$8,040.69
|
| Rate for Payer: United Healthcare All Payer |
$7,370.63
|
|
|
TRI PRESS FIT STEM 21MM*150MM
|
Facility
|
OP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem Medicaid |
$2,874.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Humana KY Medicaid |
$2,874.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI PRESS FIT STEM 21MM*150MM
|
Facility
|
IP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI PRESS FIT STEM 22MM*100MM
|
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 22MM*100MM
|
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
|
|
