|
ACE CHS PLATE 6 HOLE
|
Facility
|
IP
|
$3,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$2,964.00 |
| Rate for Payer: Aetna Commercial |
$2,377.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.25
|
| Rate for Payer: Cash Price |
$1,543.75
|
| Rate for Payer: Cigna Commercial |
$2,562.62
|
| Rate for Payer: First Health Commercial |
$2,933.12
|
| Rate for Payer: Humana Commercial |
$2,624.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.38
|
| Rate for Payer: PHCS Commercial |
$2,964.00
|
| Rate for Payer: United Healthcare All Payer |
$2,717.00
|
|
|
ACE CHS PLATE 8 HOLE
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 8 HOLE
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE DRIVING GUIDE WIRE 3.2*28
|
Facility
|
OP
|
$771.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$740.54 |
| Rate for Payer: Aetna Commercial |
$593.98
|
| Rate for Payer: Anthem Medicaid |
$265.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.69
|
| Rate for Payer: Cash Price |
$385.70
|
| Rate for Payer: Cigna Commercial |
$640.26
|
| Rate for Payer: First Health Commercial |
$732.83
|
| Rate for Payer: Humana Commercial |
$655.69
|
| Rate for Payer: Humana KY Medicaid |
$265.28
|
| Rate for Payer: Kentucky WC Medicaid |
$267.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.83
|
| Rate for Payer: Ohio Health Group HMO |
$578.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.27
|
| Rate for Payer: PHCS Commercial |
$740.54
|
| Rate for Payer: United Healthcare All Payer |
$678.83
|
|
|
ACE DRIVING GUIDE WIRE 3.2*28
|
Facility
|
IP
|
$771.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$740.54 |
| Rate for Payer: Aetna Commercial |
$593.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.69
|
| Rate for Payer: Cash Price |
$385.70
|
| Rate for Payer: Cigna Commercial |
$640.26
|
| Rate for Payer: First Health Commercial |
$732.83
|
| Rate for Payer: Humana Commercial |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.83
|
| Rate for Payer: Ohio Health Group HMO |
$578.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.27
|
| Rate for Payer: PHCS Commercial |
$740.54
|
| Rate for Payer: United Healthcare All Payer |
$678.83
|
|
|
ACE GUIDE PIN 6 IN. 3.2MM
|
Facility
|
IP
|
$449.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.89 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: Aetna Commercial |
$346.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.72
|
| Rate for Payer: Cash Price |
$224.82
|
| Rate for Payer: Cigna Commercial |
$373.20
|
| Rate for Payer: First Health Commercial |
$427.16
|
| Rate for Payer: Humana Commercial |
$382.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.68
|
| Rate for Payer: Ohio Health Group HMO |
$337.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.25
|
| Rate for Payer: PHCS Commercial |
$431.65
|
| Rate for Payer: United Healthcare All Payer |
$395.68
|
|
|
ACE GUIDE PIN 6 IN. 3.2MM
|
Facility
|
OP
|
$449.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.89 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: Aetna Commercial |
$346.22
|
| Rate for Payer: Anthem Medicaid |
$154.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.72
|
| Rate for Payer: Cash Price |
$224.82
|
| Rate for Payer: Cigna Commercial |
$373.20
|
| Rate for Payer: First Health Commercial |
$427.16
|
| Rate for Payer: Humana Commercial |
$382.19
|
| Rate for Payer: Humana KY Medicaid |
$154.63
|
| Rate for Payer: Kentucky WC Medicaid |
$156.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.68
|
| Rate for Payer: Ohio Health Group HMO |
$337.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.25
|
| Rate for Payer: PHCS Commercial |
$431.65
|
| Rate for Payer: United Healthcare All Payer |
$395.68
|
|
|
ACE GUIDE WIRE 3.2MM*38
|
Facility
|
OP
|
$1,844.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.32 |
| Max. Negotiated Rate |
$1,770.61 |
| Rate for Payer: Aetna Commercial |
$1,420.18
|
| Rate for Payer: Anthem Medicaid |
$634.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.62
|
| Rate for Payer: Cash Price |
$922.19
|
| Rate for Payer: Cigna Commercial |
$1,530.84
|
| Rate for Payer: First Health Commercial |
$1,752.17
|
| Rate for Payer: Humana Commercial |
$1,567.73
|
| Rate for Payer: Humana KY Medicaid |
$634.29
|
| Rate for Payer: Kentucky WC Medicaid |
$640.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.63
|
| Rate for Payer: PHCS Commercial |
$1,770.61
|
| Rate for Payer: United Healthcare All Payer |
$1,623.06
|
|
|
ACE GUIDE WIRE 3.2MM*38
|
Facility
|
IP
|
$1,844.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.32 |
| Max. Negotiated Rate |
$1,770.61 |
| Rate for Payer: Aetna Commercial |
$1,420.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.62
|
| Rate for Payer: Cash Price |
$922.19
|
| Rate for Payer: Cigna Commercial |
$1,530.84
|
| Rate for Payer: First Health Commercial |
$1,752.17
|
| Rate for Payer: Humana Commercial |
$1,567.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.63
|
| Rate for Payer: PHCS Commercial |
$1,770.61
|
| Rate for Payer: United Healthcare All Payer |
$1,623.06
|
|
|
ACE K-WIRE 1.6*6 F/SM FRAG ST
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
ACE K-WIRE 1.6*6 F/SM FRAG ST
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
ACELLULAR DERM MATRIX IMPLT
|
Facility
|
OP
|
$5,398.50
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
76100209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,619.55 |
| Max. Negotiated Rate |
$5,182.56 |
| Rate for Payer: Aetna Commercial |
$4,156.85
|
| 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 |
$5,128.57
|
| Rate for Payer: Humana Commercial |
$4,588.73
|
| 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 |
$4,318.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,696.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,724.97
|
| Rate for Payer: PHCS Commercial |
$5,182.56
|
| Rate for Payer: United Healthcare All Payer |
$4,750.68
|
|
|
ACELLULAR DERM MATRIX IMPLT
|
Facility
|
IP
|
$5,398.50
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
76100209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,619.55 |
| Max. Negotiated Rate |
$5,182.56 |
| Rate for Payer: Aetna Commercial |
$4,156.85
|
| 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 |
$5,128.57
|
| Rate for Payer: Humana Commercial |
$4,588.73
|
| 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 |
$4,318.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,696.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,724.97
|
| 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 |
$3,239.10 |
| Rate for Payer: Ambetter Exchange |
$202.41
|
| Rate for Payer: Anthem Medicaid |
$170.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.89
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$202.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.41
|
| 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 |
$263.13
|
| Rate for Payer: UHCCP Medicaid |
$1,889.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.41
|
|
|
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 |
$362.56 |
| Rate for Payer: Ambetter Exchange |
$202.41
|
| Rate for Payer: Anthem Medicaid |
$170.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.89
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$202.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.41
|
| 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 |
$263.13
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.41
|
|
|
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 |
$1,469.55 |
| 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 |
$4,653.57
|
| Rate for Payer: Humana Commercial |
$4,163.73
|
| 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 |
$3,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,261.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,379.97
|
| Rate for Payer: PHCS Commercial |
$4,702.56
|
| Rate for Payer: United Healthcare All Payer |
$4,310.68
|
|
|
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 |
$1,469.55 |
| 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 |
$4,653.57
|
| Rate for Payer: Humana Commercial |
$4,163.73
|
| 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 |
$3,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,261.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,379.97
|
| Rate for Payer: PHCS Commercial |
$4,702.56
|
| Rate for Payer: United Healthcare All Payer |
$4,310.68
|
|
|
ACEON (PERINF.) 4MGTAB
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 54011125
|
| Hospital Charge Code |
25000141
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| 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 |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
ACEON (PERINF.) 4MGTAB
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 54011125
|
| Hospital Charge Code |
25000141
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| 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 |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
ACE PLATE COMPRESSION 3.5MM 10
|
Facility
|
IP
|
$2,071.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.42 |
| Max. Negotiated Rate |
$1,988.54 |
| Rate for Payer: Aetna Commercial |
$1,594.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.69
|
| Rate for Payer: Cash Price |
$1,035.70
|
| Rate for Payer: Cigna Commercial |
$1,719.26
|
| Rate for Payer: First Health Commercial |
$1,967.83
|
| Rate for Payer: Humana Commercial |
$1,760.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,657.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,802.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.27
|
| Rate for Payer: PHCS Commercial |
$1,988.54
|
| Rate for Payer: United Healthcare All Payer |
$1,822.83
|
|
|
ACE PLATE COMPRESSION 3.5MM 10
|
Facility
|
OP
|
$2,071.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.42 |
| Max. Negotiated Rate |
$1,988.54 |
| Rate for Payer: Aetna Commercial |
$1,594.98
|
| Rate for Payer: Anthem Medicaid |
$712.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.69
|
| Rate for Payer: Cash Price |
$1,035.70
|
| Rate for Payer: Cigna Commercial |
$1,719.26
|
| Rate for Payer: First Health Commercial |
$1,967.83
|
| Rate for Payer: Humana Commercial |
$1,760.69
|
| Rate for Payer: Humana KY Medicaid |
$712.35
|
| Rate for Payer: Kentucky WC Medicaid |
$719.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,657.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,802.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.27
|
| Rate for Payer: PHCS Commercial |
$1,988.54
|
| Rate for Payer: United Healthcare All Payer |
$1,822.83
|
|
|
ACE PLATE COMPRESSION 3.5MM 12
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
ACE PLATE COMPRESSION 3.5MM 12
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
ACE PLATE COMPRESSION 3.5MM 5H
|
Facility
|
IP
|
$1,758.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.65 |
| Max. Negotiated Rate |
$1,688.50 |
| Rate for Payer: Aetna Commercial |
$1,354.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.90
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cigna Commercial |
$1,459.85
|
| Rate for Payer: First Health Commercial |
$1,670.91
|
| Rate for Payer: Humana Commercial |
$1,495.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.61
|
| Rate for Payer: PHCS Commercial |
$1,688.50
|
| Rate for Payer: United Healthcare All Payer |
$1,547.79
|
|
|
ACE PLATE COMPRESSION 3.5MM 5H
|
Facility
|
OP
|
$1,758.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.65 |
| Max. Negotiated Rate |
$1,688.50 |
| Rate for Payer: Aetna Commercial |
$1,354.31
|
| Rate for Payer: Anthem Medicaid |
$604.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.90
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cigna Commercial |
$1,459.85
|
| Rate for Payer: First Health Commercial |
$1,670.91
|
| Rate for Payer: Humana Commercial |
$1,495.02
|
| Rate for Payer: Humana KY Medicaid |
$604.87
|
| Rate for Payer: Kentucky WC Medicaid |
$611.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.61
|
| Rate for Payer: PHCS Commercial |
$1,688.50
|
| Rate for Payer: United Healthcare All Payer |
$1,547.79
|
|
