|
UNIVERSAL STEM 115*16MM FLUTED
|
Facility
|
OP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem Medicaid |
$4,352.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Humana KY Medicaid |
$4,352.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*18MM FLUTED
|
Facility
|
IP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*18MM FLUTED
|
Facility
|
OP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem Medicaid |
$4,352.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Humana KY Medicaid |
$4,352.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*22MM FLUTED
|
Facility
|
OP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem Medicaid |
$4,352.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Humana KY Medicaid |
$4,352.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*22MM FLUTED
|
Facility
|
IP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*24MM FLUTED
|
Facility
|
IP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 115*24MM FLUTED
|
Facility
|
OP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem Medicaid |
$4,765.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Humana KY Medicaid |
$4,765.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,813.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,860.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*10MM FLUTED
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
UNIVERSAL STEM 150*10MM FLUTED
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
UNIVERSAL STEM 150*12MM FLUTED
|
Facility
|
OP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem Medicaid |
$4,352.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Humana KY Medicaid |
$4,352.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 150*12MM FLUTED
|
Facility
|
IP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 150*14MM FLUTED
|
Facility
|
OP
|
$14,271.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,281.44 |
| Max. Negotiated Rate |
$13,700.59 |
| Rate for Payer: Aetna Commercial |
$10,989.02
|
| Rate for Payer: Anthem Medicaid |
$4,907.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,131.73
|
| Rate for Payer: Cash Price |
$7,135.73
|
| Rate for Payer: Cigna Commercial |
$11,845.30
|
| Rate for Payer: First Health Commercial |
$13,557.88
|
| Rate for Payer: Humana Commercial |
$12,130.73
|
| Rate for Payer: Humana KY Medicaid |
$4,907.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,957.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,702.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,532.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,281.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,006.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,558.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,703.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,417.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,416.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,847.30
|
| Rate for Payer: PHCS Commercial |
$13,700.59
|
| Rate for Payer: United Healthcare All Payer |
$12,558.88
|
|
|
UNIVERSAL STEM 150*14MM FLUTED
|
Facility
|
IP
|
$14,271.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,281.44 |
| Max. Negotiated Rate |
$13,700.59 |
| Rate for Payer: Aetna Commercial |
$10,989.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,131.73
|
| Rate for Payer: Cash Price |
$7,135.73
|
| Rate for Payer: Cigna Commercial |
$11,845.30
|
| Rate for Payer: First Health Commercial |
$13,557.88
|
| Rate for Payer: Humana Commercial |
$12,130.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,702.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,532.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,281.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,558.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,703.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,417.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,416.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,847.30
|
| Rate for Payer: PHCS Commercial |
$13,700.59
|
| Rate for Payer: United Healthcare All Payer |
$12,558.88
|
|
|
UNIVERSAL STEM 150*16MM FLUTED
|
Facility
|
OP
|
$9,993.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.02 |
| Max. Negotiated Rate |
$9,593.66 |
| Rate for Payer: Aetna Commercial |
$7,694.92
|
| Rate for Payer: Anthem Medicaid |
$3,436.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,794.85
|
| Rate for Payer: Cash Price |
$4,996.70
|
| Rate for Payer: Cigna Commercial |
$8,294.52
|
| Rate for Payer: First Health Commercial |
$9,493.73
|
| Rate for Payer: Humana Commercial |
$8,494.39
|
| Rate for Payer: Humana KY Medicaid |
$3,436.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,471.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,194.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,375.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,998.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,505.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,794.19
|
| Rate for Payer: Ohio Health Group HMO |
$7,495.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,994.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,694.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,895.45
|
| Rate for Payer: PHCS Commercial |
$9,593.66
|
| Rate for Payer: United Healthcare All Payer |
$8,794.19
|
|
|
UNIVERSAL STEM 150*16MM FLUTED
|
Facility
|
IP
|
$9,993.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.02 |
| Max. Negotiated Rate |
$9,593.66 |
| Rate for Payer: Aetna Commercial |
$7,694.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,794.85
|
| Rate for Payer: Cash Price |
$4,996.70
|
| Rate for Payer: Cigna Commercial |
$8,294.52
|
| Rate for Payer: First Health Commercial |
$9,493.73
|
| Rate for Payer: Humana Commercial |
$8,494.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,194.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,375.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,998.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,794.19
|
| Rate for Payer: Ohio Health Group HMO |
$7,495.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,994.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,694.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,895.45
|
| Rate for Payer: PHCS Commercial |
$9,593.66
|
| Rate for Payer: United Healthcare All Payer |
$8,794.19
|
|
|
UNIVERSAL STEM 150*18MM FLUTED
|
Facility
|
IP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*18MM FLUTED
|
Facility
|
OP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem Medicaid |
$4,765.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Humana KY Medicaid |
$4,765.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,813.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,860.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*20MM FLUTED
|
Facility
|
OP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem Medicaid |
$4,765.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Humana KY Medicaid |
$4,765.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,813.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,860.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*20MM FLUTED
|
Facility
|
IP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*22MM FLUTED
|
Facility
|
IP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*22MM FLUTED
|
Facility
|
OP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem Medicaid |
$4,765.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Humana KY Medicaid |
$4,765.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,813.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,860.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*24MM FLUTED
|
Facility
|
IP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 150*24MM FLUTED
|
Facility
|
OP
|
$13,856.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,157.02 |
| Max. Negotiated Rate |
$13,302.47 |
| Rate for Payer: Aetna Commercial |
$10,669.69
|
| Rate for Payer: Anthem Medicaid |
$4,765.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,808.26
|
| Rate for Payer: Cash Price |
$6,928.37
|
| Rate for Payer: Cigna Commercial |
$11,501.09
|
| Rate for Payer: First Health Commercial |
$13,163.90
|
| Rate for Payer: Humana Commercial |
$11,778.23
|
| Rate for Payer: Humana KY Medicaid |
$4,765.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,813.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,226.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,157.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,860.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,392.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,055.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,561.15
|
| Rate for Payer: PHCS Commercial |
$13,302.47
|
| Rate for Payer: United Healthcare All Payer |
$12,193.93
|
|
|
UNIVERSAL STEM 75*10MM FLUTED
|
Facility
|
IP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 75*10MM FLUTED
|
Facility
|
OP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem Medicaid |
$4,352.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Humana KY Medicaid |
$4,352.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
