|
UNIVERSAL STEM 75*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 75*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 75*14MM 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 75*14MM 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 75*16MM 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 75*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 75*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 75*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 75*20MM 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 75*20MM 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 75*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 75*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 75*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*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
|
|
|
UNIVERS APEX STEM 5MM
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM 5MM
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM 6MM
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM 6MM
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM 7MM
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM 7MM
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM SZ 10MM
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM SZ 10MM
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM SZ 11MM
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM SZ 11MM
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
UNIVERS APEX STEM SZ 13MM
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
