|
PROTRUSIO CAGES 52*49 R
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 56*53 L
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 56*53 L
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 56*53 R
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 56*53 R
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 60*57 L
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 60*57 L
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 60*57 R
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 60*57 R
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 64*61 L
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 64*61 L
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 64*61 R
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 64*61 R
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 68*65 L
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 68*65 L
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 68*65 R
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 68*65 R
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 72*69 L
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 72*69 L
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 72*69 R
|
Facility
|
IP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROTRUSIO CAGES 72*69 R
|
Facility
|
OP
|
$11,260.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,378.28 |
| Max. Negotiated Rate |
$10,810.51 |
| Rate for Payer: Aetna Commercial |
$8,670.93
|
| Rate for Payer: Anthem Medicaid |
$3,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,783.54
|
| Rate for Payer: Cash Price |
$5,630.47
|
| Rate for Payer: Cigna Commercial |
$9,346.59
|
| Rate for Payer: First Health Commercial |
$10,697.90
|
| Rate for Payer: Humana Commercial |
$9,571.81
|
| Rate for Payer: Humana KY Medicaid |
$3,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,233.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,310.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,378.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,950.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,909.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,445.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,008.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,770.06
|
| Rate for Payer: PHCS Commercial |
$10,810.51
|
| Rate for Payer: United Healthcare All Payer |
$9,909.64
|
|
|
PROVACHOL 10MG TABLET
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 93077198
|
| Hospital Charge Code |
25001263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
PROVACHOL 10MG TABLET
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 93077198
|
| Hospital Charge Code |
25001263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
PROVAYBLUE 0.5% 10ML AMPUL
|
Facility
|
IP
|
$840.43
|
|
|
Service Code
|
NDC 517037401
|
| Hospital Charge Code |
25003392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$806.81 |
| Rate for Payer: Aetna Commercial |
$647.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.54
|
| Rate for Payer: Cash Price |
$420.21
|
| Rate for Payer: Cigna Commercial |
$697.56
|
| Rate for Payer: First Health Commercial |
$798.41
|
| Rate for Payer: Humana Commercial |
$714.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$689.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$620.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.58
|
| Rate for Payer: Ohio Health Group HMO |
$630.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.90
|
| Rate for Payer: PHCS Commercial |
$806.81
|
| Rate for Payer: United Healthcare All Payer |
$739.58
|
|
|
PROVAYBLUE 0.5% 10ML AMPUL
|
Facility
|
OP
|
$840.43
|
|
|
Service Code
|
NDC 517037401
|
| Hospital Charge Code |
25003392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$806.81 |
| Rate for Payer: Aetna Commercial |
$647.13
|
| Rate for Payer: Anthem Medicaid |
$289.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.54
|
| Rate for Payer: Cash Price |
$420.21
|
| Rate for Payer: Cigna Commercial |
$697.56
|
| Rate for Payer: First Health Commercial |
$798.41
|
| Rate for Payer: Humana Commercial |
$714.37
|
| Rate for Payer: Humana KY Medicaid |
$289.02
|
| Rate for Payer: Kentucky WC Medicaid |
$291.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$689.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$620.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.58
|
| Rate for Payer: Ohio Health Group HMO |
$630.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.90
|
| Rate for Payer: PHCS Commercial |
$806.81
|
| Rate for Payer: United Healthcare All Payer |
$739.58
|
|
