|
AUGMENT LEGION UNIVERSAL SZ5 R
|
Facility
|
IP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
AUGMENT LEGION UNIVERSAL SZ5 R
|
Facility
|
OP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem Medicaid |
$3,745.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Humana KY Medicaid |
$3,745.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,783.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,820.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 L
|
Facility
|
IP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 L
|
Facility
|
OP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem Medicaid |
$3,745.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Humana KY Medicaid |
$3,745.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,783.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,820.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 R
|
Facility
|
OP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem Medicaid |
$3,745.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Humana KY Medicaid |
$3,745.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,783.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,820.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 R
|
Facility
|
IP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
AUGMENT OSS DIAP PLTFRM OSSEOT
|
Facility
|
IP
|
$16,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.98 |
| Max. Negotiated Rate |
$15,913.73 |
| Rate for Payer: Aetna Commercial |
$12,764.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,929.90
|
| Rate for Payer: Cash Price |
$8,288.40
|
| Rate for Payer: Cigna Commercial |
$13,758.74
|
| Rate for Payer: First Health Commercial |
$15,747.96
|
| Rate for Payer: Humana Commercial |
$14,090.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,592.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,233.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,973.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,587.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,432.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,315.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,154.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,138.81
|
| Rate for Payer: PHCS Commercial |
$15,913.73
|
| Rate for Payer: United Healthcare All Payer |
$14,587.58
|
|
|
AUGMENT OSS DIAP PLTFRM OSSEOT
|
Facility
|
OP
|
$16,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.98 |
| Max. Negotiated Rate |
$15,913.73 |
| Rate for Payer: Aetna Commercial |
$12,764.14
|
| Rate for Payer: Anthem Medicaid |
$5,700.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,929.90
|
| Rate for Payer: Cash Price |
$8,288.40
|
| Rate for Payer: Cigna Commercial |
$13,758.74
|
| Rate for Payer: First Health Commercial |
$15,747.96
|
| Rate for Payer: Humana Commercial |
$14,090.28
|
| Rate for Payer: Humana KY Medicaid |
$5,700.76
|
| Rate for Payer: Kentucky WC Medicaid |
$5,758.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,592.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,233.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,973.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,815.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,587.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,432.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,315.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,154.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,138.81
|
| Rate for Payer: PHCS Commercial |
$15,913.73
|
| Rate for Payer: United Healthcare All Payer |
$14,587.58
|
|
|
AUGMENT VAN PST F 57.5X5 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VAN PST F 57.5X5 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VAN PST F 62.5X5 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VAN PST F 62.5X5 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VAN PST FEM 55X5 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VAN PST FEM 55X5 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VAN PST FEM 60X5 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VAN PST FEM 60X5 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VNDR D FM 57.5X5 LL/RM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VNDR D FM 57.5X5 LL/RM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VNDR D FM 60X5 LL/RM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VNDR D FM 60X5 LL/RM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VNDR D FM 62.5X5 LL/RM
|
Facility
|
IP
|
$8,123.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.08 |
| Max. Negotiated Rate |
$7,798.72 |
| Rate for Payer: Aetna Commercial |
$6,255.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,336.46
|
| Rate for Payer: Cash Price |
$4,061.84
|
| Rate for Payer: Cigna Commercial |
$6,742.65
|
| Rate for Payer: First Health Commercial |
$7,717.49
|
| Rate for Payer: Humana Commercial |
$6,905.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,661.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,995.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,148.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,092.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.34
|
| Rate for Payer: PHCS Commercial |
$7,798.72
|
| Rate for Payer: United Healthcare All Payer |
$7,148.83
|
|
|
AUGMENT VNDR D FM 62.5X5 LL/RM
|
Facility
|
OP
|
$8,123.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.08 |
| Max. Negotiated Rate |
$7,798.72 |
| Rate for Payer: Aetna Commercial |
$6,255.23
|
| Rate for Payer: Anthem Medicaid |
$2,793.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,336.46
|
| Rate for Payer: Cash Price |
$4,061.84
|
| Rate for Payer: Cigna Commercial |
$6,742.65
|
| Rate for Payer: First Health Commercial |
$7,717.49
|
| Rate for Payer: Humana Commercial |
$6,905.12
|
| Rate for Payer: Humana KY Medicaid |
$2,793.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,822.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,661.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,995.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,849.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,148.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,092.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.34
|
| Rate for Payer: PHCS Commercial |
$7,798.72
|
| Rate for Payer: United Healthcare All Payer |
$7,148.83
|
|
|
AUGMENT VNDR D FM 65X5 LL/RM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VNDR D FM 65X5 LL/RM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
AUGMENT VNDR D FM 67.5X5 LL/RM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
