|
AUGMENT LEGION UNIVERSAL SZ4 R
|
Facility
|
IP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ5 L
|
Facility
|
OP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem Medicaid |
$3,828.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Humana KY Medicaid |
$3,828.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ5 L
|
Facility
|
IP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ5 R
|
Facility
|
IP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ5 R
|
Facility
|
OP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem Medicaid |
$3,828.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Humana KY Medicaid |
$3,828.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 L
|
Facility
|
IP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 L
|
Facility
|
OP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem Medicaid |
$3,828.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Humana KY Medicaid |
$3,828.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 R
|
Facility
|
IP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT LEGION UNIVERSAL SZ6 R
|
Facility
|
OP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem Medicaid |
$3,828.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Humana KY Medicaid |
$3,828.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
AUGMENT OSS DIAP PLTFRM OSSEOT
|
Facility
|
OP
|
$17,120.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,136.18 |
| Max. Negotiated Rate |
$16,435.78 |
| Rate for Payer: Aetna Commercial |
$13,182.86
|
| Rate for Payer: Anthem Medicaid |
$5,887.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,354.07
|
| Rate for Payer: Cash Price |
$8,560.30
|
| Rate for Payer: Cigna Commercial |
$14,210.10
|
| Rate for Payer: First Health Commercial |
$16,264.57
|
| Rate for Payer: Humana Commercial |
$14,552.51
|
| Rate for Payer: Humana KY Medicaid |
$5,887.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,947.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,038.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,635.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,136.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,005.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,840.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,696.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,894.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,813.21
|
| Rate for Payer: PHCS Commercial |
$16,435.78
|
| Rate for Payer: United Healthcare All Payer |
$15,066.13
|
|
|
AUGMENT OSS DIAP PLTFRM OSSEOT
|
Facility
|
IP
|
$17,120.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,136.18 |
| Max. Negotiated Rate |
$16,435.78 |
| Rate for Payer: Aetna Commercial |
$13,182.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,354.07
|
| Rate for Payer: Cash Price |
$8,560.30
|
| Rate for Payer: Cigna Commercial |
$14,210.10
|
| Rate for Payer: First Health Commercial |
$16,264.57
|
| Rate for Payer: Humana Commercial |
$14,552.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,038.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,635.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,136.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,840.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,696.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,894.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,813.21
|
| Rate for Payer: PHCS Commercial |
$16,435.78
|
| Rate for Payer: United Healthcare All Payer |
$15,066.13
|
|
|
AUGMENT VAN PST F 57.5X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VAN PST F 57.5X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VAN PST F 62.5X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VAN PST F 62.5X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VAN PST FEM 55X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VAN PST FEM 55X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VAN PST FEM 60X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VAN PST FEM 60X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 57.5X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 57.5X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 60X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 60X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 62.5X5 LL/RM
|
Facility
|
IP
|
$8,323.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.10 |
| Max. Negotiated Rate |
$7,990.72 |
| Rate for Payer: Aetna Commercial |
$6,409.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,492.46
|
| Rate for Payer: Cash Price |
$4,161.84
|
| Rate for Payer: Cigna Commercial |
$6,908.65
|
| Rate for Payer: First Health Commercial |
$7,907.49
|
| Rate for Payer: Humana Commercial |
$7,075.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,825.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,142.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,324.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,242.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,658.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,241.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,743.33
|
| Rate for Payer: PHCS Commercial |
$7,990.72
|
| Rate for Payer: United Healthcare All Payer |
$7,324.83
|
|
|
AUGMENT VNDR D FM 62.5X5 LL/RM
|
Facility
|
OP
|
$8,323.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.10 |
| Max. Negotiated Rate |
$7,990.72 |
| Rate for Payer: Aetna Commercial |
$6,409.23
|
| Rate for Payer: Anthem Medicaid |
$2,862.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,492.46
|
| Rate for Payer: Cash Price |
$4,161.84
|
| Rate for Payer: Cigna Commercial |
$6,908.65
|
| Rate for Payer: First Health Commercial |
$7,907.49
|
| Rate for Payer: Humana Commercial |
$7,075.12
|
| Rate for Payer: Humana KY Medicaid |
$2,862.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,891.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,825.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,142.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,324.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,242.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,658.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,241.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,743.33
|
| Rate for Payer: PHCS Commercial |
$7,990.72
|
| Rate for Payer: United Healthcare All Payer |
$7,324.83
|
|
