|
SCREW VALOR 5MM L 25MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 30MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 30MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 35MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 35MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 40MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 40MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 45MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 45MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 60MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 60MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 65MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 65MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 80MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 80MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 90MM
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCREW VALOR 5MM L 90MM
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
SCROTAL 0^ ANG CYLINDER SET 16
|
Facility
|
OP
|
$74,129.20
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,636.80 |
| Max. Negotiated Rate |
$71,164.03 |
| Rate for Payer: Aetna Commercial |
$57,079.48
|
| Rate for Payer: Anthem Medicaid |
$25,493.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,820.78
|
| Rate for Payer: Cash Price |
$37,064.60
|
| Rate for Payer: Cigna Commercial |
$61,527.24
|
| Rate for Payer: First Health Commercial |
$70,422.74
|
| Rate for Payer: Humana Commercial |
$63,009.82
|
| Rate for Payer: Humana KY Medicaid |
$25,493.03
|
| Rate for Payer: Kentucky WC Medicaid |
$25,752.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,785.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,707.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,238.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,004.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,233.70
|
| Rate for Payer: Ohio Health Group HMO |
$55,596.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,825.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,636.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,980.05
|
| Rate for Payer: PHCS Commercial |
$71,164.03
|
| Rate for Payer: United Healthcare All Payer |
$65,233.70
|
|
|
SCROTAL 0^ ANG CYLINDER SET 16
|
Facility
|
IP
|
$74,129.20
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,636.80 |
| Max. Negotiated Rate |
$71,164.03 |
| Rate for Payer: Aetna Commercial |
$57,079.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,820.78
|
| Rate for Payer: Cash Price |
$37,064.60
|
| Rate for Payer: Cigna Commercial |
$61,527.24
|
| Rate for Payer: First Health Commercial |
$70,422.74
|
| Rate for Payer: Humana Commercial |
$63,009.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,785.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,707.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,238.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,233.70
|
| Rate for Payer: Ohio Health Group HMO |
$55,596.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,825.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,636.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,980.05
|
| Rate for Payer: PHCS Commercial |
$71,164.03
|
| Rate for Payer: United Healthcare All Payer |
$65,233.70
|
|
|
SDS MEDICAL CARE ROOM RATE
|
Facility
|
IP
|
$1,679.00
|
|
| Hospital Charge Code |
11000015
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,292.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,309.62
|
| Rate for Payer: Cash Price |
$839.50
|
| Rate for Payer: Cigna Commercial |
$1,393.57
|
| Rate for Payer: First Health Commercial |
$1,595.05
|
| Rate for Payer: Humana Commercial |
$1,427.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,376.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,477.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,259.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.49
|
| Rate for Payer: PHCS Commercial |
$1,611.84
|
| Rate for Payer: United Healthcare All Payer |
$1,477.52
|
|
|
SDS UNIT ADDITION 1/2 HR
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$24.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$24.07
|
| Rate for Payer: Kentucky WC Medicaid |
$24.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
SDS UNIT ADDITION 1/2 HR
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
SEC. ART M-THROMECT ADD-ON
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 37186
|
| Hospital Charge Code |
76101527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
SEC. ART M-THROMECT ADD-ON
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 37186
|
| Hospital Charge Code |
76101527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$410.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$367.92
|
| Rate for Payer: Healthspan PPO |
$1,884.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$342.89
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$197.65
|
|
|
SEC. ART M-THROMECT ADD-ON
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 37186
|
| Hospital Charge Code |
76101527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
