|
PROTRUSIO CAGES 48*45 R
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 48*45 R
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 52*49 L
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 52*49 L
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 52*49 R
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 52*49 R
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 56*53 L
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 56*53 L
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 56*53 R
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 56*53 R
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 60*57 L
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 60*57 L
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 60*57 R
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 60*57 R
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 64*61 L
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 64*61 L
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 64*61 R
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 64*61 R
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 68*65 L
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 68*65 L
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 68*65 R
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 68*65 R
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 72*69 L
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 72*69 L
|
Facility
|
IP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
|
PROTRUSIO CAGES 72*69 R
|
Facility
|
OP
|
$11,018.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.43 |
| Max. Negotiated Rate |
$10,577.91 |
| Rate for Payer: Aetna Commercial |
$8,484.37
|
| Rate for Payer: Anthem Medicaid |
$3,789.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,594.55
|
| Rate for Payer: Cash Price |
$5,509.33
|
| Rate for Payer: Cigna Commercial |
$9,145.49
|
| Rate for Payer: First Health Commercial |
$10,467.73
|
| Rate for Payer: Humana Commercial |
$9,365.86
|
| Rate for Payer: Humana KY Medicaid |
$3,789.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,827.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,035.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,131.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,305.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,865.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,696.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,415.78
|
| Rate for Payer: PHCS Commercial |
$10,577.91
|
| Rate for Payer: United Healthcare All Payer |
$9,696.42
|
|
