|
ACE GUIDE WIRE 3.2MM*38
|
Facility
|
OP
|
$1,851.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.68 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Aetna Commercial |
$1,425.59
|
| Rate for Payer: Anthem Medicaid |
$636.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.10
|
| Rate for Payer: Cash Price |
$925.70
|
| Rate for Payer: Cigna Commercial |
$1,536.67
|
| Rate for Payer: First Health Commercial |
$1,758.84
|
| Rate for Payer: Humana Commercial |
$1,573.70
|
| Rate for Payer: Humana KY Medicaid |
$636.70
|
| Rate for Payer: Kentucky WC Medicaid |
$643.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.94
|
| Rate for Payer: PHCS Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Payer |
$1,629.24
|
|
|
ACE GUIDE WIRE 3.2MM*38
|
Facility
|
IP
|
$1,851.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.68 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Aetna Commercial |
$1,425.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.10
|
| Rate for Payer: Cash Price |
$925.70
|
| Rate for Payer: Cigna Commercial |
$1,536.67
|
| Rate for Payer: First Health Commercial |
$1,758.84
|
| Rate for Payer: Humana Commercial |
$1,573.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.94
|
| Rate for Payer: PHCS Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Payer |
$1,629.24
|
|
|
ACE K-WIRE 1.6*6 F/SM FRAG ST
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
ACE K-WIRE 1.6*6 F/SM FRAG ST
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
ACELLULAR DERM MATRIX IMPLT
|
Facility
|
OP
|
$5,398.50
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
76100209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$5,182.56 |
| Rate for Payer: Aetna Commercial |
$4,156.84
|
| Rate for Payer: Anthem Medicaid |
$1,856.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,210.83
|
| Rate for Payer: Cash Price |
$2,699.25
|
| Rate for Payer: Cigna Commercial |
$4,480.76
|
| Rate for Payer: First Health Commercial |
$5,128.58
|
| Rate for Payer: Humana Commercial |
$4,588.72
|
| Rate for Payer: Humana KY Medicaid |
$1,856.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,426.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,750.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.54
|
| Rate for Payer: PHCS Commercial |
$5,182.56
|
| Rate for Payer: United Healthcare All Payer |
$4,750.68
|
|
|
ACELLULAR DERM MATRIX IMPLT
|
Professional
|
Both
|
$5,398.50
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
76100209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.66 |
| Max. Negotiated Rate |
$5,398.50 |
| Rate for Payer: Anthem Medicaid |
$170.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,398.50
|
| Rate for Payer: Cash Price |
$2,699.25
|
| Rate for Payer: Cash Price |
$2,699.25
|
| Rate for Payer: Cigna Commercial |
$362.56
|
| Rate for Payer: Healthspan PPO |
$199.92
|
| Rate for Payer: Humana Medicaid |
$170.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.07
|
| Rate for Payer: Molina Healthcare Passport |
$170.66
|
| Rate for Payer: Multiplan PHCS |
$3,239.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,778.95
|
| Rate for Payer: UHCCP Medicaid |
$1,889.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.37
|
|
|
ACELLULAR DERM MATRIX IMPLT
|
Facility
|
IP
|
$5,398.50
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
76100209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$5,182.56 |
| Rate for Payer: Aetna Commercial |
$4,156.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,210.83
|
| Rate for Payer: Cash Price |
$2,699.25
|
| Rate for Payer: Cigna Commercial |
$4,480.76
|
| Rate for Payer: First Health Commercial |
$5,128.58
|
| Rate for Payer: Humana Commercial |
$4,588.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,426.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,750.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.54
|
| Rate for Payer: PHCS Commercial |
$5,182.56
|
| Rate for Payer: United Healthcare All Payer |
$4,750.68
|
|
|
ACELLULAR DERM MATRIX IMPLT(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
761P0209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.66 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Anthem Medicaid |
$170.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$362.56
|
| Rate for Payer: Healthspan PPO |
$199.92
|
| Rate for Payer: Humana Medicaid |
$170.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.07
|
| Rate for Payer: Molina Healthcare Passport |
$170.66
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.37
|
|
|
ACELLULAR DERM MATRIX IMPLT(T
|
Facility
|
IP
|
$4,898.50
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
761T0209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.80 |
| Max. Negotiated Rate |
$4,702.56 |
| Rate for Payer: Aetna Commercial |
$3,771.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,820.83
|
| Rate for Payer: Cash Price |
$2,449.25
|
| Rate for Payer: Cigna Commercial |
$4,065.76
|
| Rate for Payer: First Health Commercial |
$4,653.58
|
| Rate for Payer: Humana Commercial |
$4,163.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,016.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,615.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,310.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,673.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$979.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$636.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.54
|
| Rate for Payer: PHCS Commercial |
$4,702.56
|
| Rate for Payer: United Healthcare All Payer |
$4,310.68
|
|
|
ACELLULAR DERM MATRIX IMPLT(T
|
Facility
|
OP
|
$4,898.50
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
761T0209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.80 |
| Max. Negotiated Rate |
$4,702.56 |
| Rate for Payer: Aetna Commercial |
$3,771.84
|
| Rate for Payer: Anthem Medicaid |
$1,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,820.83
|
| Rate for Payer: Cash Price |
$2,449.25
|
| Rate for Payer: Cigna Commercial |
$4,065.76
|
| Rate for Payer: First Health Commercial |
$4,653.58
|
| Rate for Payer: Humana Commercial |
$4,163.72
|
| Rate for Payer: Humana KY Medicaid |
$1,684.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,701.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,016.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,615.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,718.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,310.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,673.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$979.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$636.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.54
|
| Rate for Payer: PHCS Commercial |
$4,702.56
|
| Rate for Payer: United Healthcare All Payer |
$4,310.68
|
|
|
ACEON (PERINF.) 4MGTAB
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 54011125
|
| Hospital Charge Code |
25000141
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
ACEON (PERINF.) 4MGTAB
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 54011125
|
| Hospital Charge Code |
25000141
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
ACE PLATE COMPRESSION 3.5MM 10
|
Facility
|
IP
|
$2,060.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.86 |
| Max. Negotiated Rate |
$1,978.08 |
| Rate for Payer: Aetna Commercial |
$1,586.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.19
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cigna Commercial |
$1,710.22
|
| Rate for Payer: First Health Commercial |
$1,957.48
|
| Rate for Payer: Humana Commercial |
$1,751.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.76
|
| Rate for Payer: PHCS Commercial |
$1,978.08
|
| Rate for Payer: United Healthcare All Payer |
$1,813.24
|
|
|
ACE PLATE COMPRESSION 3.5MM 10
|
Facility
|
OP
|
$2,060.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.86 |
| Max. Negotiated Rate |
$1,978.08 |
| Rate for Payer: Humana Commercial |
$1,751.42
|
| Rate for Payer: Humana KY Medicaid |
$708.61
|
| Rate for Payer: Kentucky WC Medicaid |
$715.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.76
|
| Rate for Payer: PHCS Commercial |
$1,978.08
|
| Rate for Payer: United Healthcare All Payer |
$1,813.24
|
| Rate for Payer: Aetna Commercial |
$1,586.58
|
| Rate for Payer: Anthem Medicaid |
$708.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.19
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cigna Commercial |
$1,710.22
|
| Rate for Payer: First Health Commercial |
$1,957.48
|
|
|
ACE PLATE COMPRESSION 3.5MM 12
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
ACE PLATE COMPRESSION 3.5MM 12
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
ACE PLATE COMPRESSION 3.5MM 5H
|
Facility
|
IP
|
$1,772.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.44 |
| Max. Negotiated Rate |
$1,701.72 |
| Rate for Payer: Aetna Commercial |
$1,364.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.64
|
| Rate for Payer: Cash Price |
$886.31
|
| Rate for Payer: Cigna Commercial |
$1,471.27
|
| Rate for Payer: First Health Commercial |
$1,683.99
|
| Rate for Payer: Humana Commercial |
$1,506.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,559.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.51
|
| Rate for Payer: PHCS Commercial |
$1,701.72
|
| Rate for Payer: United Healthcare All Payer |
$1,559.91
|
|
|
ACE PLATE COMPRESSION 3.5MM 5H
|
Facility
|
OP
|
$1,772.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.44 |
| Max. Negotiated Rate |
$1,701.72 |
| Rate for Payer: Aetna Commercial |
$1,364.92
|
| Rate for Payer: Anthem Medicaid |
$609.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.64
|
| Rate for Payer: Cash Price |
$886.31
|
| Rate for Payer: Cigna Commercial |
$1,471.27
|
| Rate for Payer: First Health Commercial |
$1,683.99
|
| Rate for Payer: Humana Commercial |
$1,506.73
|
| Rate for Payer: Humana KY Medicaid |
$609.60
|
| Rate for Payer: Kentucky WC Medicaid |
$615.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,559.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.51
|
| Rate for Payer: PHCS Commercial |
$1,701.72
|
| Rate for Payer: United Healthcare All Payer |
$1,559.91
|
|
|
ACE PLATE COMPRESSION 3.5MM 6H
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
ACE PLATE COMPRESSION 3.5MM 6H
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
ACE PLATE COMPRESSION 3.5MM 7H
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
ACE PLATE COMPRESSION 3.5MM 7H
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
ACE PLATE COMPRESSION 3.5MM 8H
|
Facility
|
OP
|
$1,976.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.94 |
| Max. Negotiated Rate |
$1,897.44 |
| Rate for Payer: Aetna Commercial |
$1,521.90
|
| Rate for Payer: Anthem Medicaid |
$679.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,541.67
|
| Rate for Payer: Cash Price |
$988.25
|
| Rate for Payer: Cigna Commercial |
$1,640.50
|
| Rate for Payer: First Health Commercial |
$1,877.68
|
| Rate for Payer: Humana Commercial |
$1,680.02
|
| Rate for Payer: Humana KY Medicaid |
$679.72
|
| Rate for Payer: Kentucky WC Medicaid |
$686.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,620.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,458.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$693.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,739.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,482.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$1,897.44
|
| Rate for Payer: United Healthcare All Payer |
$1,739.32
|
|
|
ACE PLATE COMPRESSION 3.5MM 8H
|
Facility
|
IP
|
$1,976.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.94 |
| Max. Negotiated Rate |
$1,897.44 |
| Rate for Payer: Aetna Commercial |
$1,521.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,541.67
|
| Rate for Payer: Cash Price |
$988.25
|
| Rate for Payer: Cigna Commercial |
$1,640.50
|
| Rate for Payer: First Health Commercial |
$1,877.68
|
| Rate for Payer: Humana Commercial |
$1,680.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,620.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,458.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,739.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,482.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$1,897.44
|
| Rate for Payer: United Healthcare All Payer |
$1,739.32
|
|
|
ACE PLATE COMPRESSION 3.5MM 9H
|
Facility
|
OP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem Medicaid |
$594.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Humana KY Medicaid |
$594.26
|
| Rate for Payer: Kentucky WC Medicaid |
$600.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
