|
ACCORD GUIDEWIRE .040 (1.02M)
|
Facility
|
OP
|
$1,578.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna Commercial |
$1,215.15
|
| Rate for Payer: Anthem Medicaid |
$542.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.93
|
| Rate for Payer: Cash Price |
$789.06
|
| Rate for Payer: Cigna Commercial |
$1,309.84
|
| Rate for Payer: First Health Commercial |
$1,499.21
|
| Rate for Payer: Humana Commercial |
$1,341.40
|
| Rate for Payer: Humana KY Medicaid |
$542.72
|
| Rate for Payer: Kentucky WC Medicaid |
$548.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$553.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.22
|
| Rate for Payer: PHCS Commercial |
$1,515.00
|
| Rate for Payer: United Healthcare All Payer |
$1,388.75
|
|
|
ACCUFILL INJ BONE SUB MAT 3CC
|
Facility
|
IP
|
$11,979.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.36 |
| Max. Negotiated Rate |
$11,500.51 |
| Rate for Payer: Aetna Commercial |
$9,224.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.17
|
| Rate for Payer: Cash Price |
$5,989.85
|
| Rate for Payer: Cigna Commercial |
$9,943.15
|
| Rate for Payer: First Health Commercial |
$11,380.72
|
| Rate for Payer: Humana Commercial |
$10,182.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,593.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,984.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,713.71
|
| Rate for Payer: PHCS Commercial |
$11,500.51
|
| Rate for Payer: United Healthcare All Payer |
$10,542.14
|
|
|
ACCUFILL INJ BONE SUB MAT 3CC
|
Facility
|
OP
|
$11,979.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.36 |
| Max. Negotiated Rate |
$11,500.51 |
| Rate for Payer: Aetna Commercial |
$9,224.37
|
| Rate for Payer: Anthem Medicaid |
$4,119.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.17
|
| Rate for Payer: Cash Price |
$5,989.85
|
| Rate for Payer: Cigna Commercial |
$9,943.15
|
| Rate for Payer: First Health Commercial |
$11,380.72
|
| Rate for Payer: Humana Commercial |
$10,182.74
|
| Rate for Payer: Humana KY Medicaid |
$4,119.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,161.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,593.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,202.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,984.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,713.71
|
| Rate for Payer: PHCS Commercial |
$11,500.51
|
| Rate for Payer: United Healthcare All Payer |
$10,542.14
|
|
|
ACCUPRIL (QUINAPRIL) 20MG TAB
|
Facility
|
IP
|
$22.16
|
|
|
Service Code
|
NDC 71053223
|
| Hospital Charge Code |
25000137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.87
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACCUPRIL (QUINAPRIL) 20MG TAB
|
Facility
|
OP
|
$22.16
|
|
|
Service Code
|
NDC 71053223
|
| Hospital Charge Code |
25000137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Anthem Medicaid |
$7.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Humana KY Medicaid |
$7.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.87
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACCUPRIL(QUINAPRIL)5 MG TABLET
|
Facility
|
IP
|
$22.16
|
|
|
Service Code
|
NDC 71052723
|
| Hospital Charge Code |
25000138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.87
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACCUPRIL(QUINAPRIL)5 MG TABLET
|
Facility
|
OP
|
$22.16
|
|
|
Service Code
|
NDC 71052723
|
| Hospital Charge Code |
25000138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Anthem Medicaid |
$7.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Humana KY Medicaid |
$7.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.87
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACE CHS PLATE 10 HOLE
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 10 HOLE
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 12 HOLE
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 12 HOLE
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 14 HOLE
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 14 HOLE
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 2 HOLE
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 2 HOLE
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 4 HOLE
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
ACE CHS PLATE 4 HOLE
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
ACE CHS PLATE 6 HOLE
|
Facility
|
OP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.95 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem Medicaid |
$1,105.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Humana KY Medicaid |
$1,105.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.65
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
ACE CHS PLATE 6 HOLE
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.95 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.65
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
ACE CHS PLATE 8 HOLE
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE CHS PLATE 8 HOLE
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
ACE DRIVING GUIDE WIRE 3.2*28
|
Facility
|
OP
|
$754.26
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.05 |
| Max. Negotiated Rate |
$724.09 |
| Rate for Payer: Aetna Commercial |
$580.78
|
| Rate for Payer: Anthem Medicaid |
$259.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.32
|
| Rate for Payer: Cash Price |
$377.13
|
| Rate for Payer: Cigna Commercial |
$626.04
|
| Rate for Payer: First Health Commercial |
$716.55
|
| Rate for Payer: Humana Commercial |
$641.12
|
| Rate for Payer: Humana KY Medicaid |
$259.39
|
| Rate for Payer: Kentucky WC Medicaid |
$262.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$618.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$556.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$663.75
|
| Rate for Payer: Ohio Health Group HMO |
$565.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.82
|
| Rate for Payer: PHCS Commercial |
$724.09
|
| Rate for Payer: United Healthcare All Payer |
$663.75
|
|
|
ACE DRIVING GUIDE WIRE 3.2*28
|
Facility
|
IP
|
$754.26
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.05 |
| Max. Negotiated Rate |
$724.09 |
| Rate for Payer: Aetna Commercial |
$580.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.32
|
| Rate for Payer: Cash Price |
$377.13
|
| Rate for Payer: Cigna Commercial |
$626.04
|
| Rate for Payer: First Health Commercial |
$716.55
|
| Rate for Payer: Humana Commercial |
$641.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$618.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$556.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$663.75
|
| Rate for Payer: Ohio Health Group HMO |
$565.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.82
|
| Rate for Payer: PHCS Commercial |
$724.09
|
| Rate for Payer: United Healthcare All Payer |
$663.75
|
|
|
ACE GUIDE PIN 6 IN. 3.2MM
|
Facility
|
IP
|
$446.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Aetna Commercial |
$343.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.28
|
| Rate for Payer: Cash Price |
$223.26
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$424.18
|
| Rate for Payer: Humana Commercial |
$379.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$366.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.93
|
| Rate for Payer: Ohio Health Group HMO |
$334.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.42
|
| Rate for Payer: PHCS Commercial |
$428.65
|
| Rate for Payer: United Healthcare All Payer |
$392.93
|
|
|
ACE GUIDE PIN 6 IN. 3.2MM
|
Facility
|
OP
|
$446.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Aetna Commercial |
$343.81
|
| Rate for Payer: Anthem Medicaid |
$153.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.28
|
| Rate for Payer: Cash Price |
$223.26
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$424.18
|
| Rate for Payer: Humana Commercial |
$379.53
|
| Rate for Payer: Humana KY Medicaid |
$153.55
|
| Rate for Payer: Kentucky WC Medicaid |
$155.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$366.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.93
|
| Rate for Payer: Ohio Health Group HMO |
$334.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.42
|
| Rate for Payer: PHCS Commercial |
$428.65
|
| Rate for Payer: United Healthcare All Payer |
$392.93
|
|
